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HomeMy WebLinkAboutHenry, John 0/° 00 JUDITH T.TERRY ���_� tk,‘ Town Hall, 53095 Main Road TOWN CLERK - = P.O. Box 1179 vr- rn � Southold, New York 11971 REGISTRAR OF VITAL STATISTICS O MARRIAGE OFFICER �1�' Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER °l * '. ,,.' 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. 1508 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 REPLACE EXISTING CESSPOOL WITH NEW TYPE. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner HENRY, JOHN P. Mailing Address 1 MIDWOOD DRIVE City St Zip CUTCHOGUE NY 11935 Property Address 1 MIDWOOD DRIVE City St Zip CUTCHOGUE NY 11935 Tax Map No. section 110.00 block 3 lot 32.000 Cross Street PEQUASH AVENUE Building Permit Number Cross Reference: Issue Date: 7/17/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) o�•StFFO(,tC t� JUDITH T.TERRY ��� Town Hall, 53095 Main Road TOWN CLERK ; N Z P.O. Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER if' 0 �s Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER : �I * �a�d� 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: July 17, 1996 Transmitted herewith is a copy of application No. 1573 for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for John P. Henry 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 - DISAPPROVE - COMMENTS: Maintain required setbacks from adjacent wells, buildings, property lines and water bodies. EXCAVATION INSPECTION REQUIRED. Signatur- C— Da - OFFICE OF THE TOWN" CLERK ,,,'""" Town of Southold Judith T. Terry, Town Clerk 11046' C�Gy Application No. /5 ,3 Town Hall, 53095 Main Road !� Construction P. O. Box 1179 ; o rn Southold, New York 11971 s t!'i Alteration Telephone �,j, �,,����'1 $10.00 - Residential ' r� (516) 765-1801 _ .1 4 ,, $25.00 -Non-Residential • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $_ �/L DATE ���' / / Cti APPLICANT NAME: / / �� i/, -.;.-., 414111P APPLICANT ADDRESS: �/, fiavy 972..- SEPTIC CESSPOOL? DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION �O,R ALTERAT ON: OWNER OF PROPERTY: ,.7 Q - - " r OWNER MAILING ADDRESS: -, i ca . ,, OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON: f� TAX MAP NO. : Section 1/0 Block 3‘ Lot 3 ?i CROSS STREET: A - BUILDING PERMIT NUMBER CROS REFERENCE: nature o Applicant RECEIVED BY : Town Clerk's Office DATE: • 0 �► lid .tv1ff f* ll Ivl '