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Home My WebLink AboutChisholm, Joseph SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3645 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1: P 0 BOX 487 City St Zip LAUREL NY 11948 Descripton of Proposed Construction or Alteration REPLACE EXISTING SYSTEM APPROVED AS SUBMITTED - MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS BUILDINGS, PROPERTY LINES AND WATER BODIES. Name Of Owner CHISHOLM, JOSEPH ------------------------------ Mailing Address 1 P 0 BOX 313 ------------------------------ ------------------------------ City St Zip LAUREL NY 11948 -------------------- -- ---------- Property Address 1 200 MCDONLDS CROSSING ------------------------------ ------------------------------ City St Zip LAUREL NY 11948 -------------------- -- ---------- Tax Map No. section 145.00 block 4 lot 16.000 ------ --- ------ Cr'oss Street ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 6/06/08Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) �oF SO(/j�, ELIZABETH A.NEVILLE � Ol0 Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR,OF VITAL STATISTICS Southold, New York 11971 u� MARRIAGE OFFICER �r Fax(631) 765-6145 p � RECORDS MANAGEMENT OFFICER �O Telephone(631) 765-1$00 FREEDOM OF INFORMATION OFFICER ��yCOU NTd,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD r TO: Southold Town Building Department SUN 200$ LJ?1 FROM: Linda J. Cooper, Southold Town Clerk's Office ------ - ------ j 3Lu(I'l -)L'nl 0F SGJTHL)LD DATED: June 4, 2008 Transmitted herewith is a copy of application No. 3806 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Joseph Chisholm 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. Linda J. Cooper 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 Dated �oF sorry ELIZABETH A.NEVILLE �� 1 Town Hall, 53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER N Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER �lyCOO,Nc� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: June 4,2008 Transmitted herewith is a copy of application No. 3806 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Joseph Chisholm 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. Linda J. Cooper 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 Dated ELIZABETH A.NEVILLE �`Z` �Gy Town Hall, 53095 Main Road TOWN CLERK o P.O.Box 1179 ti Z Southold,New York 11971 REGISTRAR,OF VITAL STATISTICS V� Fax(631) 765-6145 MARRIAGE OFFICER Hifi � � Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER ��! �a FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net r OFFICE OF THE TOWN CLERK TOWN OF SOUT14OLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10x or Non-Residential @$25 Application No. Permit No. ` J VCS Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. 0. BOX 487 _ LAUREL, NEW YORK 1194.8_ Septic Tank or Cesspool Brief Descyiptioof Proposed Co 'on or Alteration Location of Proposed Cons ction/Alteration: Am Owner of Property: 05e tS Owner Mailing Address: fo (OO K 3 t 13 Owner Property Address: 400 I '1 G Vl old S 1Y-D5 S' Name and phone number of contact person —�S�CJ�- Tax Map No: Section Block Lot Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH AP LICATION. NEW CONSTRUCTION REQUIRES SURVEYWI EALTH DEP AR ENT APPROVAL igna App cant Da Received by:L ° �� l 9� �9� 3�. u8� �' I�oo� � I � 'M C �u Vl ) �(oS5 i