HomeMy WebLinkAboutCongdon, Pat �, 0$UFF014.
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JUDITH T. TERRY �� 'l� Town Hall, 53095 Main Road
TOWN CLERK
N = P.O. Box 1179
u n. Q Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O ��
MARRIAGE OFFICER �� , 1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ;�Q( , 4; Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 00.°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1689 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PAT CONGDON
Address 1 : 5000 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
REPLACE EXISTING CESSPOOL.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner CONGDON, PAT
Mailing Address 1 5000 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948
Property Address 1 5000 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948
Tax Map No. section 128.00 block 4 lot 1 .000
Cross Street BIRCH LANE
Building Permit Number Cross Reference:
Issue Date: 6/17/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �'��O 'j� Town Hall, 53095 Main Road
TOWN CLERK t 4:= _ P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %, O # Fax(516) 765-1823
MARRIAGE OFFICER
illi *a , Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER �l d° P
FREEDOM OF INFORMATION OFFICER Os
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 13, 1997
Transmitted herewith is a copy of application No. 1759 for a Cesspool/
Septic Tank Construction Permit submitted by:
Ray Nine for Pat Congdon .
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 MIsL.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recomm ndations:
APPROVE
DISAPPROVE
Comments:
RECEIVED �____
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,JUN 1 1910 , Signatu
Dated
SOLOOld Town C.�r4
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'OFFICE OF THE TOWN CLERK '''"""
Town of Southold ,`��C�� F�O�KL' "
Judith T. Terry, Town Clerk ,' �l/y�:; Application No.
Town Hall, 53095 Main Road Construction
P. O. Box 1179 , *,
Southold, New York 11971 . 1.11Alteration l/
Telephone �Q�i� $10.00 - Residential
(516) 765-1801 ' l
r
,0 ' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
DATE _--. (/f
13 / `' 7
APPLICANT NAME: I j9 / G all/ 6. A0)1/
APPLICANT ADDRESS: fF•c 6n.>c 61y4i /J 'j
L-dy� .E )t- f/ • /14 NP
SEPTIC CESSPOOL ,//
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
E X IST /W6 rUG1i
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: � / / ,PJf'? LONG //`9✓y
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: /2 -c Ol•i t c 019 9 L12-1'12
TELEPHONE NUMBER OF CONTACT PERSON: � 9� • �� ��'
TAX MAP NO. : Section py Block y-f Lot /
CROSS STREET : 8 // G y (i p J,r
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Si.n/ ire of (pplic int/rf<
RECEIVED BY :
Town C eric's Office
DATE: Cp// `j���
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