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Home My WebLink AboutHiggins, Patrick SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3609 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : COASTLINE CESSPOOL & DRAIN SER Address 1: 4225 BRIDGE LANE City St Zip CUTCHOGUE NY 11935 Descripton of Proposed Construction or Alteration -INSTALL 1000 GIN SEPTIC TANK & (1) 8X12 LEACHING POOL -MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,BUILINGS,PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED Name Of Owner PATRICK HIGGINS ------------------------------ Mailing Address 1 2 KENILWORTH DRIVE ------------------------------ ----------------------- ------ City ----------------------------------------------------------- City St Zip SHORT HILLS NJ 7078 -------------------- -- ---------- Property Address 1 410 JACKSON STREET ------------------------------ ------------------------------ City St Zip NEW SUFFOLK NY 11956 -------------------- -- ---------- Tax Map No. section 117.00 block 10 lot 3�0 ------ --- ------ Cross Street NEW SUFFOLK ROAD ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 12/13/07 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLE ��0f SU(/jy0 Town Hall, 53095 Main Road TOWN CLERK ~� l0 P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER G Q Fax(631) 765-6145 RECORDS MANAGEMENT-OFFICERa0 Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER -lCOU '� ' southoldtown.northfork.net DEC T 200I OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: December 6, 2007 Transmitted herewith is a copy of application No. 3766 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Coastline Cesspool for Patrick Higgins Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Michelle Martocchia I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. Signature % I too— Dated . o��S0FF0�,�coG ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK p P.O. Box 1179 Go = Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ap MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER ®'� �a southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10\ or Non-Residential @ $25 Application No. %- Permit No. (p0� Applicant Name O Sc 4 Applicant Mailing Address �(l Septic Tank %/or Cesspool V Brief Description of Proposed Construction or Alterations ,Ce�A C -�Q oyC S�-(l') S x l k_�2C Y)\YAC t Location of Proposed Construction/Alteration: Owner of Property: R�A6dy" 4�G c r-)s Owner Mailing Address: 5k y_er'l ti \u,-C�J A_S-) \ Y Shcrr-� �St\\S, k':Yl C)�j C`A - leo Q`( Owner Property Address: � Name and phone number of contact person Tax Map No: Section \C)M Block\� ) Lot _ Cross Street �\4in NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES Y WITH HEALTH DEPARTMENT APPROVAL e of Applicant Date Received by: