HomeMy WebLinkAboutBirkel, R JUDITH T.TERRY t•
�� y1 Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS
1$ Southold, New York 11971
MARRIAGE OFFICER � /I� O ��1Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER : Ol l ' ',,1' 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. 1769 R Residential X Non-Residential
Fee $ 10.00 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 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 BIRKEL, R.
Mailing Address 1 565 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 565 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 75.00 block 4 lot 1 .000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
4
Issue Date: 11/14/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 1 1...- t\ Town Hall, 53095 Main Road
TOWN CLERK 1 o - P.O. Box 1179
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‘ �y 4,,, � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O �� Fax(516) 765-1823
MARRIAGE OFFICER =*4, �0\IO Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER .( � ' a�O
FREEDOM OF INFORMATION OFFICER vim,. ,,,' .
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OFFICE OF THE TOWN CLERK -I, i 2 199 .)
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TOWN OF SOUTHOLD
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BLDG.DEPT.
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Ccoper, Southold Town Clerk's Office
DATED: November 10, 1997
Transmitted herewith is a copy of application No. 1843 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Cesspool for R. Birkel .
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following rec mendations:
APPROVE '
DISAPPROVE
Comments:
Signat iiiro,
, t1, 4/4 '1
Dated
OFFICE OF THE TOWN• CLERK ,s"
Town of Southold ��'', ,FFOt/( " cS
Judith T. Terry, Town Clerk 4‘'' % �l/y Application Noe
Town Hall, 53095 Main Road .•G = Construction I------'
P. O. Box 1179 ; v mi -
Alteration
Southold, New York 11971 .v' ���' ------- ---
'toe
Gl„. ���ri• $10.00 - Residential A----
Telephone
(516) 765-1801 'We1
$25.00 -Non-Residential
i , y
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE` l�/7/ 7 _.._
APPLICANT .NAME: / ..e..••/1
_ / - -6i ,., / _�
APPLICANT ADDRESS: i• d,„,) 22,
--,-; ! _��___- -- -- —_-__.
SEPTIC CESSPOOL (/
DESCRIPTION OF PROPOSED CONSTRUCTI
ON OR ALTERATION
Lit_ ____ Y-- ___ �sG,�r�"�`-
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTVATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: ,56 S 6-04:4e.01-4--4-6-1- 'f.--le.
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: p,Vg-� % 65 k_
TAX MAP NO. : Section 7 S` Block 41 Lot / JV
CROSS STREET : I
BUILDING PERMIT NUMBER CROSS REFERENCE:
_.4/1— a,_____ __.
___Art-e.
Signature of Appli jnt
RECEIVED BY:
RE ► fflerk's Office
DATE:
N O V 10 1997
Southold Town Clerk
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