The URL can be used to link to this page

Home My WebLink AboutJacobs �oF soar ELIZABETH A.NEVILLE ,`O� yOIO Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER G • Q Fax(631) 765-6145 RECORDS AGEMENT OFFICER 31) 765-1800 FREEDOM OF INFORMATION OFFICER �Oly�'��IV 1�, s utholdtowTelephone n nor hfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3590 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1: Pb BOX 972 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration -ADDING ADDITIONAL OVERFLOW TO EXISTING SYSTEM -MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES Name Of Owner JEAN JACOBS ------------------------------ Mailing Address 1 PO BOX 331 ------------------------------ ------------------------------ City St Zip SOUTHOLD NY 11971 -------------------- -- ---------- Property Address 1 285 OLD WOOD PATH ------------------------------ ------------------------------ City St Zip SOUTHOLD NY 11971 -------------------- -- ---------- Tax Map No. section 87.00 block 1 lot 200 ------ --- ------ Cross Street SOUTH HARBOR ROAD ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 10/26/07 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) \pF SOUry , ELIZABETH A.NEVILLE ®� �� Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER G Q Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER a0 Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER OI�Cou southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD y, liV a Tb: d,Tow uilding Department FRO N"f Michelle L. Martocchia, Southold Town Clerk's Office DATED: October 1, 2007 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 3748 for a Cesspool/Septic Tank Construction/Alteration Permit submitted by: Peconic Cesspool for Jean Jacobs 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 DISAPPROVE Comments: Signature `d ® � d Dated J -,k_1 o�OS�FfOC,g-�O ELIZAIIETH A.NEVILLE � Gy Town Hall, 53095 Main Road P.O. Box 1179 TOWN CLERK y Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS n9 MARRIAGE OFFICER Fax(631) 765-6145 sf� � �� Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER ��l �� 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 ential 10 � or Non-Residential $25 Application N031 Resld @$ @ Permit No. Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. O. BOX 972 MATTITUCK, NEW YORK 11952 Septic Tank or Cesspool L-' Brief Description of Proposed Construction or Alteration L fes, Loc tion of Proposed Constru ion/Alterat on: Owner of Property: A�.� Owner Mailing Address: �3 3 fv it e-q -7 i Owner Property Address: ag- s- CU L'f� Name and phone number of contact person Tax Map No: Section 4l 7 Block Lot 'Z- Cross Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Signature of Applicant Date Received by: l f� r 285 OLD WOOD PATH SOUTHOLD 3 1 a � v yr s s r 5 � i t � _ _�-- 1 r�;•,/L�,; +.�. �—�--`.._...-lam