HomeMy WebLinkAboutBufkins, Douglas 011 of F014-
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JUDITH T.TERRY �� Town Hall, 53095 Main Road
TOWN CLERK ; y i P.O. Box 1179
v. I Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y4 %NV IleFax(516) 765-1823
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RECORDS MANAGEMENT OFFICER - '?I . �,� 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. 1480 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
REPLACE EXISTING SYSTEM WHICH CAVED IN.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner BUFKINS, DOUGLAS & MARLENE
Mailing Address 1 595 TUCKERS LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 595 TUCKERS LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 11 lot 4.000
Cross Street CLOVER STREET
Building Permit Number Cross Reference:
Issue Date: 5/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �' _� yt Town Hall, 53095 Main Road
TOWN CLERK ; N = P.O. Box 1179
v-% �t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % O
MARRIAGE OFFICER yijJ �' Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER D. * NV-,� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER •~.„ ,••.
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department is MN "' 9 1996 '
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 9, 1996 T". DEPT.
Transmitted herewith is a copy of application No. A1542 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Douglas & Marlene Bufkins
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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. Fri I g E 0 W E r',
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Thank you.
MAY 1 0 1996 I
I
Linda J. Cooper BLDG.DEPT.
TOWN OF SOUTHOLD
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I have reviewed the application and location map of the project listed
above and make the followiinng recommendation:
APPROVE - v
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Date
OFFICE OF THE TOWN' CLERK ,,''""
Town of Southold ,•'1�c)IfOIk�• -
Judith T. Terry, Town Clerk o'�� l/y Application No. /
Town Hall, 53095 Main Road ;� . . : Construction L�
P. O. Box 1179 - `
Southold, New York 11971 Alteration
Telephone ,j� �O�i� $10.00 - Residential
(516) 765-1801 y0.1 * 'r
,r $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: "a-e---r)vi--c-,
APPLICANT ADDRESS: /'d /1->9‘
__--_---
SEPTIC CESSPOOL
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: / 4 • 141
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OWNER MAILING ADDRESS: ',S 9
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ��.— g f $g. VJ __
TAX MAP NO. : Section Block 1/ Lot .
CROSS STREET: 0,en)
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BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of A licant
RECEIVED BY:
Town Cerk's Office
DATE:
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