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Home My WebLink AboutBurt h0��of SouTyol ELIZABETH A. NEVILLE Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N Southold, New York 11971 MARRIAGE OFFICER �Q Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERl Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER yCQU +� 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. 3576 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1: PO BOX 972 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration FILL IN OULD BLOCK POOL AND REPLACE WITH NEW TYPE MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES Name Of Owner CLAY & ELIZABETH BURT ------------------------------ Mailing Address 1 PO BOX 809 ------------------------------ -- --------------------------- City ----------------------------------------------------------- City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Property Address 1 7155 WICKHAM AVE ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Tax Map No. section 107.00 block 5 lot 500 ------ --- ------ Cross Street ELIJAH'S LANE ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 9/11/07 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) q s®Uryo ELIZABETH A. NEVILLE h0 1 Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER G Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERfly ^tea Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER CQUsoutholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLDSE � � 'I P 2007 TO: Southold Town Building Department BLDG. DEPT. FROM: Michelle L. Martocchia, Southold Town Clerk's Office ` 7 WPB F SOUT4�(OLD � DATED: September 5, 2007 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 3735 for a Cesspool/Septic Tank Construction/Alteration Permit submitted by: Peconic Cesspool for Clay & Elizabeth Burt Please review the application and location map and advise if this office may issue the permit. Please complete the form below and return it to me. Thank you. I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVV�E Comments: or i Signature Dated f i i ELIZABETH A.NEVILLE a`Z` Town Hall, 53095 Main Road TOWN CLERK o P.O. Box 1179 W 2 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER ® Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER ��1 �� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER 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 t or Non-Residential @$25 Application NZ D35— Permit N4 Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. 0. Box 972 MATTITUCK, NEW YORK 11952 Septic Tank or Cesspool r/ Brief Description of Proposed Construction or Alteration it/ 041 Location of Proposed Construction/Alteration: Owner of Property: (� - Owner Mailing Address: 0 6: 0"4�f Ahk Owner Property Address: 7l SS ait.,te Name and phone number of contact person Tax Map No:: Section 10 *7 Block Lot Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW 1_CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL lie 4_9� A"z: Signature of Applicant Date Received by: q S 16 7 CLAY & ELIZABETH BURT 7155 WICKHAM AVENUE MATTITUCK 7j Y fps