HomeMy WebLinkAboutCox, Helen 0°. 000 ararl,
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JUDITH T.TERRY I _ ?L`. Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
�1 Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER = 0.1 1111as"`1►aTelephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER '•v,• ,•��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1564 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 COX, HELEN
Mailing Address 1 1300 TRACK AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 1300 TRACK AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 137.00 block 2 lot 2.000
Cross Street STILLWATER AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/01/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY t t% Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER -�yifJ 0� ��/' Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �l . ," Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,0"'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 24, 1996
Transmitted herewith is a copy of application No. A1628 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Helen Cox
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 - 1/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature
Ar/;20,‘
Date
OFFICE OF THE TOWN' CLERK •,jFfOIK�►"-
Town of Southoldfri ‘
Judith T. Terry, Town Clerk l/y t Application N
Town Hall, 53095 Main Road �� Construction
P. O. Box 1179
Southold, New York 11971 :73 rn; Iteration
Telephone ,�'� $10.00 - Residential_
(516) 765-1801 _ 1 1 , ,, ' $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 /64(74
APPLICANT NAME:
_____Are.4/7pc...0„,
APPLICANT ADDRESS: I / *PIP IL
SEPTIC CESSPOOL
iDESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALERATION:
OWNER OF PROPERTY: (-071— -
OWNER MAILING ADDRESS: /..-L
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: -9d — 16 S
TAX MAP NO. : Section /_ 7 Block -Lot
CROSS STREET: S&ert
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature . Applicant
RECEIVED BY: Z-2. 4111,.
- o C erk's Office
DATE:
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