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Home My WebLink AboutMattituck Motel offotA- i, • JJ DITH T.TERRY � y�c Town Hall, 53095 Main Road TOWN CLERK N i P.O. Box 1179 P t Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ifi � 1� Fax (516) 765-1823 MARRIAGE OFFICER ?f� 0 �,i� Telephone (516) 765-1800 RECORDS MANAGEMENT OFFICER 1 1 1` , FREEDOM OF INFORMATION OFFICER 0� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 67 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 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 MOTEL Mailing Address 1 BAY AVENUE City St Zip MATTITUCK NY 11952 Property Address 1 BAY AVENUE City St Zip MATTITUCK NY 11952 Tax Map No. section 144.00 block 3 lot 3.006 Cross Street BARTLEY ROAD Building Permit Number Cross Reference: Issue Date: 4/09/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) /� ,ii�� ,1'' ��FF0 /0 k / isoA Gy JUDITH T.TERRY t r4 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 =��1 'k' ��0 Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER - l� �� FREEDOM OF INFORMATION OFFICER .,,,, ,4"s f OFFICE OF THE TOWN CLERK 1, ' TOWN OF SOUTHOLD . _ s TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office N ' n DATED: April 2, 1996 Transmitted herewith is a copy of application No. A1516 for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Mattituck Motel • 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 - v DISAPPROVE - COMMENTS: Maintain required setbacks from adjacent wells, buildings, property lines and water bodies. EXCAVATION INSPECTION REQUIRED. RECEIVED = - :" „lar ,,SGL Signat ,- APR -APR 9 1996 96 Town Clerk Southold OFFICE OF THE TOWN' CLERK ,,,,""""- Town of Southold .11"cwFF0t Judith T. Terry, Town Clerk %`10, G Application No. /574 Town Hall, 53095 Main Road ; Construction P. O. Box 1179 ` - -- ri Alteration_ Southold, New York 11971 ✓ Telephone = 0 �� / $10.00 - Residential (516) 765-1801 1jit $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 APPLICANT NAME: "fi-e4-7/e.t.., &46-7Arit-e APPLICANT ADDRESS: A , /s 971. _* _ SEPTIC CESSPOOL 1/ DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: .74, -a` t_. /,174 OWNER MAILING ADDRESS: OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON: (99,-96� TAX MAP NO. : Section / / 9 Block 3 Lot 3, 4. CSS STREET: _- BUILDING PERMIT NUMBER CROSS REFERENCE: RECEIVED :. PR 1996, Signature of A licant RECEIVED BY: town ellerk Southold // / L & Town Clerk's�Office DATE: 11 _..__________,,______ _.._. ,,, fri,--(-- , _______________, i........_ j i A r' 1 (k4f6wd r NIL". in oT6- ,./,i... t L.1 ,°;/9 L 6.-c 5/0d p ol i k-—1 e 1j_ L� 1 Alp •C I A Al , 5 iAl 1 G I4 F 1 1