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Home My WebLink AboutMattituck Fire District (2) Odre Off' JUDITH T.TERRYG'y� Town Hall, 53095 Main Road TOWN CLERK ; r/3 "� P.O. Box 1179 14. rft Southold, New York 11971 REGISTRAR OF VITAL STATISTICS p �1 MARRIAGE OFFICER �‘ y �1 Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER ;�0,( .�� Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER - So'�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 80 N Residential Non-Residential X Fee $ 25.00 Septic Cesspool X PERMIT ISSUED TO: Name : MATTITUCK FIRE DISTRICT Address 1 : 1000 PIKE STREET City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration ADDITION OF CESSPOOL TO AN EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner MATTITUCK FIRE DISTRICT Mailing Address 1 1000 PIKE STREET 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: 9/26/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) ,, , ,pSUF FOL,- eo JUDITH T.TERRY Town Hall, 53095 Main Road TOWN CLERK ; y P.O. Box 1179 0.• nr 1 Southold,New York 11971 REGISTRAR OF VITAL STATISTICST •RAR ��1, Fax(516) 765-1823 MARRIAGE OFFICER L RECORDS MANAGEMENT OFFICER 0.! 4 `1,- 1�� Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER , ,oto OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office DATED: September 25, 1997 Transmitted herewith is a copy of application No. 1810 for an ALTERATION PERMIT for a cesspool or septic system submitted by Ray Nine for the Mattituck Fire District • 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 applicati n and location map of the project listed above and make the followi g recommendation: APPROVE - DISAPPROVE - COMMENTS: Maintain required setbacks from adjacent wells, buildings, property lines and water bodies. EXCAVATION INSPECTION REQUIRED. Signatu e 9/ 2 c L —2 Date OFFICE OF THE TOWN CLERK Town of Southold •'� ' gt/i Application No. iel Judith T. Terry, Town Clerk �� ► Town Hall, 53095 Main Road ; Construction P. 0. Box 1179 1114 Alteration Southold, New York 11971 Telephone 1�" ,f' $10.00 -Residential p _ , ,� (516) 765-1801 $25.00 -Non-Residential • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ 25, DATE V1 /11//1 APPLICANT NAME: hi sir IT ycZ f/ RF P/r7 /Cr APPLICANT ADDRESS: ,ieVd p)Jc p S7 IJ E E';T gT7J7GrcA ` Ivy l/' Sz SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION 0' ERATIO /UP D (/Eg- FLO C12- LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: j prr17 IfG.0 )) 1/f52 OWNER MAILING ADDRESS: //fvo f/tE OWNER PROPERTY ADDRESS: /ft TELEPHONE NUMBER OF CONTACT PERSON: 298— &T 3a TAX MAP NO. : Section Ma Block 3 Lot /1 -/ CROSS STREET: 4diG le 'W' BUILDING PERMIT NUMBER CROSS REFERENCE: 4nature of Applicant RECEIVED BY: "�: ----� o),41 Clerk's Office DATE: 77 o if a rr:,ftJ IA/ affk, ark E