HomeMy WebLinkAboutBurger, Gene ,•�,���S�FFO(,��o
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
,$ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �. 4t °, 0 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICERfl �►� 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. 1464 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 A CESSPOOL 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 BURGER, GENE
Mailing Address 1 2515 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 2515 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 3 lot 4.000
Cross Street STERLING ROAD
Building Permit Number Cross Reference:
Issue Date: 4/18/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
y••,,i i� /
OFFOUr
yJ► Town Hall, 53095 Main Road
JUDITH T.TERRY �� <
TOWN CLERK ; y x P.O. Box 1179
1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `may �.. Fax (516) 765-1823
MARRIAGE OFFICER •4f9 �����1 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER - l ��.
FREEDOM OF INFORMATION OFFICER .••��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD7phuOS�0 NN101
11/30*DalB
TO: Southold Town Building Department per,
FROM: Linda Cooper, Southold Town Clerk's Office awl aist
DATED: April 17, 1996 "
a
Transmitted herewith is a copy of application No. A1524 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Gene Burger
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 - l/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature
Date
•
OFFICE OF ,THE TOWN' CLERK ,,,'"'" %.,
Town of Southold �oilic,��,�FO(�(
C� Application No. 2
Judith T. Terry, Town Clerk ��' Gy'; �
Town Hall, 53095 Main Road ;� Construction
P. O. Box 1179 ; o rn
Southold, New York 11971 •til W$ Alteration -------- -
Telephone =04.,, ��O�,i� $10.00 - Residential L�
(516) 765-1801 1 4 ,, ' $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: P.2 -e.r>z.vc--
APPLICANT ADDRESS: /:(2 -y 97z
i
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR TION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: c9-S- / S'- /2c-i. am .. .c,._ '
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: c — 'á — 9 6 rTI v_
TAX MAP NO. : Section 1o9- Block 3 Lot _ — �,
CROSS STREET : —_-.7.- 1---6-1.---/._
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Sign/11.--Ia re o Applicant
RECEIVED BY:_✓
Town erk's Office
DATE: Y /i7 Z �4
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