HomeMy WebLinkAboutMattituck Fire District �- F --
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JUDITH T.TERRY ��� y� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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Southold,New York 11971
REGISTRAR OF VITAL STATISTICS O 4 �,
MARRIAGE OFFICER ij� A.V.0Fax(516) 765-1823
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RECORDS MANAGEMENT OFFICER : .( * �d 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. 68 N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MATTITUCK FIRE DISTRICT
Address 1 : P. O. BOX 666
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
INSTALLATION OF TWO RINGS 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 MATTITUCK FIRE DISTRICT
Mailing Address 1 P. O. BOX 666
City St Zip MATTITUCK NY 11952
Property Address 1 1000 PIKE STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 3 lot 11 .001
Cross Street WICKHAM AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/06/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �/0y1 Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
irt Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ‘%°61 ���, Fax(516) 765-1823
MARRIAGE OFFICER ?f ap��i� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER 1 4 '��
FREEDOM OF INFORMATION OFFICER .0°1
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t " (hR
OFFICE OF THE TOWN CLERK s 0 b
TOWN OF SOUTHOLD3 14V r
TO: Southold Town Building Department I /,
FROM: Linda Cooper, Southold Town Clerk's Office r°wtioi)4b p7.
DATED: May 1, 1996 "Uta
Transmitted herewith is a copy of application No. A 1533 NR for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Mattituck Park District (work by Ray Nine) ,
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
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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.
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Signature
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OFFICE OF THE TOWN CLERK ,,,
Town of Southold /0"1/(&%.
Judith T. Terry, Town ClerkApplication No. /5-3 3
Town Hall, 53095 Main Road ! Construction
P. O. Box 1179 Alteration [/
Southold, New York 11971
Telephone = �� $10.00 - Residential
(516) 765-1801 _ Alt
„ ,, $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 April 29, 1996
APPLICANT NAME: Mattituck Fire District LO /�L [
APPLICANT ADDRESS: 1000 Pike Street
Mattituck, NY 11952
SEPTIC CESSPOOL x
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Installation of two ( 2) 4 'x8 ' pre cast rings with traffic
bearing cover and cast iron cover, as an expansion of existing
system,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Mattituck Fire District
OWNER MAILING ADDRESS: p 0 Box 666 , 1000 Pike Street
Mattituck, NY 11952
OWNER PROPERTY ADDRESS: Same as above
TELEPHONE NUMBER OF CONTACT PERSON: 298-8837
TAX MAP NO. : Section1000 Block 140 Lot 03-11 . 1
CROSS STREET: Wickham Ave.
BUILDING PERMIT NUMBER CROSS REFERENCE:
CS," ct.F.A
J Signature of Applicant
John C. Harrison, Commissioner
RECEIVED BY:
Town Clerk s ffice
DATE: /-j�
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