HomeMy WebLinkAboutNorth Fork Bank 1,,„ ilii��
` ,,soo\oSUFFO(�-�o -
JUDITH T.TERRY ���=� y1 Town Hall, 53095 Main Road
TOWN CLERK % N Z P.O.t Box 1179
v. $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y11, �0 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER 4q1 iii * ��i� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER '—..„ .01°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 62 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
REPLACE OLD CESSPOOL WITH NEW TYPE.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner NORTH FORK BANK
Mailing Address 1 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 6 lot 13.001
Cross Street NEW SUFFOLK ROAD
Building Permit Number Cross Reference:
Issue Date: 11/14/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
40,
I� 'StFFOt,t,0
i' � G �.
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ; y = ; P.O. Box 1179
Ivy t Southold, New York 11971
REGISTRAR OF VITAL STATISTICSOy l ,�� � Fax (516) 765-1823
MARRIAGE OFFICER � �J1 *;811° Telephone Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER - J ,�1
FREEDOM OF INFORMATION OFFICER ,�•�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
`�f/
FROM: Linda Cooper, Southold Town Clerk's Office 91995
DATED:
Transmitted herewith is a copy of application No. A1469 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for North Fork Bank •
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 - G�
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Adir
Sig ature /
/7 mac. , --
Date
8
OFFICt OF THE TOWN CLERK ,,,'""" -.,
Town of Southold .'' , 0UL/(`' A-
�'J _ 0 y
Judith T. Terry, Town Clerk �.0,% Gy Application No. / &e'
Town Hall, 53095 Main Road ; Construction
P. O. Box 1179
Southold, New York 11971 cn yc • Alteration
Telephone ;`'0 � • $10.00 - Residential
�.
(516) 765-1801 = 01 � ,, ' $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 / / ? 9 s
APPLICANT NAME: — e - - (116/:-
depAPPLICANT ADCiro.
/
L//
SEPTIC CESSPOOL
DESCRIPTI N OF PROPOSED CONSTRUCTION OR ALTERATIO 4 42.E G`t2
,/ Aige42 tfrt_
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION 0 TERATIO '��✓
OWNER OF PROPERTY: L-7112r/
OWNER MAILING ADDRESS: , -% j-4'
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: C;
TAX MAP NO. : Section /0 Block Lot I ),
VReSS STREET:
BUILDING PERMIT NUMBER CROSS E_ERENCE:
At
Signature of Applicant'
RECEIVED BY: �i,/ �i
wn r Mice
DATE: ////0 •
•
47/
F67 0-55,e oZ
ersvoof 1411
•
6-144-27.1'
$.4'4