HomeMy WebLinkAboutFlick, Hans —
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JUDITH T.TERRY t�� y� Town Hall, 53095 Main Road
TOWN CLERK • 0 P.O. Box 1179
ti p • Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %•114
Fax(516) 765-1823
MARRIAGE OFFICER yWe aQ�'��� Telephone (516) 765-1800
RECORDS AGEMENT OFFICER - Alk
FREEDOM OF NF 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. 1597 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 ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner FLICK, HANS
Mailing Address 1 P. O. BOX 433
City St Zip SOUTHOLD NY 11971
Property Address 1 1200 CEDAR POINT DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 90.00 block 2 lot 21 .000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 3/19/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY =�0 OGyl Town Hall, 53095 Main Road
TOWN CLERK ` y P.O. Box 1179
T %
REGISTRAR OF VITAL STATISTICS ; Southold, New York 11971
MARRIAGE OFFICER ‘‘46/,f, 0��,��� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER 0l * 4.• 10 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER °is° �
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD MAR 6 1997
TO: Southold Town Building Department BLDG. DEPTMMOFSO:'
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 3, 1997
Transmitted herewith is a copy of application No. 1685 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Hans Flick
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 - t/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
RECEIVED z
Signatur
MAR 1 9 1997 /Vy 7
Date
Southold Toren 1".m,w
OFFICE OF THE TOWN CLERK ,.'''
�
Tow:: of Southold
Judith �T. Terry, Town Clerk `� �� �C�
Town Hall, 53095 Main Road G Application No. /6E-5--
P, O. Box 1179 _ _ ; Construction z-/
Southold, New York 11971 • �"-
Alteration
Telephone = ��Q�/'$ $10.00 - Residential
(516) 765-1801 : Ql
•
I, $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 LeZ 0,4
APPLICANT NAME: &4,017-e
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
-----------
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR LT RATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: /oati0 �j_
G
,0010
� _
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 027,-
TAX MAP NO. : Section 9) Block JZ/ Lot
-
CROSS STREET:
BUILDING PERMIT NUMBER CROSSe.Litit:444,4t REFERENCE:
- //
Signature of Applican /
RECEIVED BY:
own Clerk's Office
DATE:
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