HomeMy WebLinkAboutFaught, Lynn )1• AN% F SOti
ELIZABETH A.NEVILLE 01 4O l0 ; Town Hall, 53095 Main Road
TOWN CLERK * z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G Q ,i Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ir'C � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ . RUNTY i �������
o,s° southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3544 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LYNN FAUGHT
Address 1: 2009 BELMONT RD NW APT#401
City St Zip WASHINGTON DC 20009
Descripton of Proposed Construction or Alteration
ALTERATION TO EXISTING SYSTEM.
MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,BUILDINGS,PROPERTY LINE
S AND WATER BODIES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner LYNN FAUGHT
Mailing Address 1 2009 BELMONT RD NW APT 401
City St Zip WASHINGTON DC 20009
Property Address 1 405 LAKE DRIVE
City St Zip SOUTHOLD NY11971
Tax Map No. section 59.00 block 5 lot ,2-:IbCrZ k
Cross Street KENNY'S ROAD
Building Permit Number Cross Reference:
Issue Date: 6/01/07 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
2,
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ELIZABETH A.NEVILLE 1
, % Town Hall, 53095 Main Road
TOWN CLERK ; 4 • 4 k P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS ; o Q 1�
Southold, New York 11971
MARRIAGE OFFICER 4 Fax 1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER .;O4ti ���\,1111 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - . �U �(�,�� southoldtown.northfork.net
\\
V, lr' OFFICE OF THE TOWN CLERK
} 7 TOWN OF SOUTHOLD
TOy� 1, Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 14, 2007
Transmitted herewith is a copy of application No. 3709 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Lynn Faught
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. .
/
F7/
Signature
a,3730 7
Dated
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ELIZABETH A.NEVILLE �'� �� 53095 Main Road
Town Hall,
TOWN CLERK ( 2 ; P.O. Box 1179
err
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER Fax D).i��, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER : l * '0,0° Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APP ATION
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v•potiftwomomisimcr
CESSPOOL or SEPTIC TANK
Residential @$10 / or Non-Residential @$25 Application No. 370 '
Permit No.5 51'1L1
Owner Name I n n 4Lh+
Owner Mailing Address p9OO9 &)ma rTI &a' A)1,0 4c/'. /O1
0)06hMn o DC, G.16609 - "-/A6
Owner Property Address 4-1 CY /e, Q r j ie
c o-I-ha1 i I I /
Owner Telephone No. 4Oc Nc3 `'
Tax Map No: Section 5"ci Block 5 Lot r?1
Cross Street Kenn iidrxJ
Please check each that applies: New Construction
Alteration to Existing System ✓
Residential V Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
A009: '3 I )-v1
111f4 Signature of Applicant Date
Received bY: rV
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