HomeMy WebLinkAboutMagan, Theodore Y I, II#• d.-
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JUDITH T.TERRY 1 Town Hall, 53095 Main Road
TOWN CLERK ti = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 0 � Southold,New York 11971
MARRIAGE OFFICER 4, �-00 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER .� 41, j►�s,l Telephone(516)765-1800
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. 56 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
ADDITION OF AN OVERFLOW CESSPOOL 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 MAGAN, THEODORE
Mailing Address 1 368 PARK AVENUE SOUTH
City St Zip NEW YORK NY 0000
Property Address 1 11160 MAIN ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 122.00 block 3 lot 9.000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 3/23/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY .r4 Town Hall, 53095 Main Road
TOWN CLERK H Z P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O .FSouthold,New York 11971
MARRIAGE OFFICER 1ijJ Q� ►►► Fax(516)765-1823
RECORDS MANAGEMENT OFFICER Od l asd► Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER .��� ,�'1'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD MAR
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office , ; --
yJ, :;OF i tr
DATED: March 17, 1995 yam"'" yfit',.
Transmitted herewith is a copy of application No. A1350 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Theodore Macon
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.
41111
Signat e
Date
OFFICE OF THE TOWN CLERK ""
Town of Southold ,'''�s'FF 1LIr1 _ � / 1 3SQ
Judith T. Terry, Town Clerk �l/ Application filo,/"
Town Hall, 53095 Main Road 1 ,...f
Construction
P. O. Box 1179 ' ~ M �
Southold, New York 11971 s to Alteration `
Telephone O,j► �l-�' $10.00 - Residential e----'' /
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(516) 765-1801 = �1 l ;, �' $25.00 - Non-Residential '-'
--- -,.,.,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ pj
DATE M`� /7, 0995
APPLICANT NAME: Pee-e2te,C-- /
APPLICANT ADDRESS: /'6 ,' z
SEPTIC CESSPOOL C—
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1,-,-lee .& -Z-C2
.t- 25' * .----,,Iredae.-.0-.7
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR CTION OR ALTERAi444_
N:
OWNER OF PROPERTY: '
OWNER MAILING ADDRESS: 3 ' f2 a., c CCt.
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OWNER PROPERTY ADDRESS: ///41P zftic.`-'V •✓� -
TELEPHONE NUMBER OF CONTACT PERSON: 02- —'9( 5-r
TAX MAP NO. : Section /,V Block 3 Lot �f
GROOS STREET: Azdy
BUILDING PERMIT NUMBER CROSS REFERENCE:
c
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ignatur o pplicant
RECEIVED BY:
( .,
T n Clerk's Office
DATE: 5 ? �
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