HomeMy WebLinkAboutCelic Realtors ,,0.,o�,g�F F0(, 00
JUDITH T.TERRY ��� y< Town Hall, 53095 Main Road
TOWN CLERK t (53 = P.O. Box 1179
$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
. 1 �! � Fax (516) 765-1823
MARRIAGE OFFICER -I%) 0°.
RECORDS
Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER _ 1 �`
FREEDOM OF INFORMATION OFFICER "�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 63 N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
NEW OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner CELIC REALTORS (BOB CELIC)
Mailing Address 1 MAIN ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 MAIN ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 143.00 block 3 lot 1 .000
Cross Street MARLENE LANE
Building Permit Number Cross Reference:
Issue Date: 11/21/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
JUDITH T.TERRY �� y< Town Hall, 53095 Main Road
TOWN CLERK ; y = P.O. Box 1179
v �$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � Oy ��� Fax(516) 765-1823
MARRIAGE OFFICER i
RECORDS MANAGEMENT OFFICER �•( *G-0116 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
�I,
OFFICE OF THE TOWN CLERK '0 It ;
TOWN OF SOUTHOLD
TO: Southold Town Building Department NM 1 6 X995
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 15, 1995
Transmitted herewith is a copy of application No. A1474 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Celic Realtors
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 this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature
Dat
OFFICE OF THE TOWN CLERK ,,,'"""'"' •
Town of Southold �'' �40[11.k�'� = Application No. 7
,��
Judith T. Terry, Town Clerk G
Town Hall, 53095 Main Road Z Construction._
P. O. Box 1179p �
Southold, New York 11971 yrs Alteration
Telephone $���',i� $10.00 - Residential
(516) 765-1801 _ 1 41 $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 'f ,!5 1
APPLICANT NAME: 61-179-7-14"{
APPLICANT ADDRESS: ,',6) /' �7 t
SEPTIC CESSPOOL Z/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
o � �
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: / �.rt`1 // �.
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / ( I3
Block 6.3 Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
�l Sign ure of Applicant
RECEIVED BY: / -1t / 2�
Tow Clerk's Office
DATE: f //'
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