HomeMy WebLinkAboutCubban, Robert /e,,
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JUDITH T.TERRY ��AV Gyj ITown Hall, 53095 Main Road
TOWN CLERK N i P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y� O�/,1�� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER •� * `�4lIi Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER —.~.. ,1 '
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 111.92 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 AN OVERFLOW 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 CUBBAN, ROBERT
Mailing Address 1 1900 PARK AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 1900 PARK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 8 lot 6.000
Cross Street MARRATOOKA ROAD
Building Permit Number Cross Reference:
Issue Date: 6/11/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY i= yL Town Hall, 53095 Main Road
TOWN CLERK % N x % P.O. Box 1179
• ��� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER 41* At / Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER RI 4 lz°,0d0 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER .�,,, ,•1
OFFICE OF THE TOWN CLERK i` '_
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office Et,- . _�;_jT
L TOWN Cor SOUTHOLD i
DATED: June 10, 1996
Transmitted herewith is a copy of application No. 1557 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Robert Cubban .
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.
`r.'-/t. L cc
—
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
ignatu - /'
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OFFICE ,O F T}-IE TOWN CLERK ,,,,,,,,,,-"
Town of Southold '�-
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Town Clerk CO‘-'‘:
Application No., -T-75
Judith T. Terry,
Town Hall, 53095 Main Road Construction P. O. Box 1179
Southold, New York 11971 tcfsAlteration
Tele hone ,>f' 0.4' $10.00 - Residential (s
p
(516) 765-1801 ,, ' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 0154-7LULL J (O, 19 9(0
APPLICANT NAME: �,f '�-yvL�, Cre4,7497-xr
APPLICANT ADDRESS: p / 972-
SEPTIC
72_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: &'A6 f!- "
OWNER MAILING ADDRESS: / t/-17
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: <2/-. g
TAX MAP NO. : Section /)..3 Block k Lot c
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
� I
Signature of A i nt
RECEIVED BY:
Town Clerk's Office
DATE:
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