HomeMy WebLinkAboutDougherty, Brian ''��•iii
ELIZABETH A.NEVILLE 4 Town Hall, 53095 Main Road
TOWN CLERK ; p -� P.O. Box 1179
Co) = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 'I Fax (516) 765-1823
MARRIAGE OFFICER �=
RECORDS MANAGEMENT OFFICER y�iol 0' � 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. 1863 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 CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner DOUGHERTY, BRIAN
Mailing Address 1 56 DEHAN STREET
City St Zip SMITHTOWN NY 11787
Property Address 1 1300 GRATHWOHL ROAD
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 4 lot 17.000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/18/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
„op/Ii S /Pa`a
ELIZABETH A.NEVILLE h`Z� G.y �� Town Hall, 53095 Main Road
TOWN CLERK p . P.O. Box 1179
• C# 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICSO Fax Fax(516) 765-1823
MARRIAGE OFFICER `` # i
RECORDS MANAGEMENT OFFICER _ �� � �1� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 13, 1998
Transmitted herewith is a copy of application No. 1937 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Brian Dougherty
•
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. y�
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.
�. •
Signa u e
6-1/ x 18
Date
OFFICE OF THE TOWN .CLERK ���''"�
Town of Southold �,''" tVOL ' - 7
�) Application No. ' ��
Judith T. Terry, Town Clerk ��� Gy ►.--�_..
Town Hall, 53095 Main Road ; # ; . Construction
P. O. Box 1179 ; v Mr
Southold, New York 11971 FA
yC�; Alteration
Telephone
-_ •o•„_ .4,r/ $10.00 - Residential
i ��_
P
(516) 765-1801 �l 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 {`�A,hg`
i
APPLICANT NAME: ...ej/-/ �-G- 'i ;i j//-
APPLICANT ADDRESS: s" 44.w _
93--S "'_ _k //95?-
SEPTIC
EPTIC CESSPOOL AV-
DESCRIPTION OF PROPO§ED CONSTRUCTION OR ALTE •AT ION
.e- / _.., . ,..,". .,....-_, ZW-c-- ! ' , - ........ .,„ .."
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY :_ __._.... '9z •d,„„- / 'u' .... .. ..
OWNER MAILING ADDRESS: .56 DE% . " s721._er
5 t _ /M 44, f/7f7 --
OWNER PROPERTY ADDRESS: J jtio _ rj 'Olj,J Li
4__i_e _
//,95
TELEPHONE NUMBER OF CONTACT PERSON: Aft_ 9c-51
TAX MAP NO. : Section / /7 Block Lot 1
CROSS STREET : �_� , � _ --
BUILDING PERMIT NUMBER CROSS REFERENCE:
�.tod.----'. -r- ii ' _
Signatu -e of Apples
RECEIVED BY :
Town erk's��,� �
Office
DATE: AlMa--_
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