HomeMy WebLinkAboutHiggins, Patrick 'I,,iii
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JUDITH T.TERRY 1._ G'yl�`� Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y ,�� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER =.49d , *90 0. Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER , ,•ors
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1686 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 HIGGINS, PATRICK
Mailing Address 1 206 WATCHUNG FORK
City St Zip WESTFIELD NJ 7090
Property Address 1 580 OLD SALT ROAD
SALT LAKE VILLAGE
City St Zip MATTITUCK N7 11952
Tax Map No. section 144.00 block 5 lot 12.000
Cross Street RACHEL PLACE
Building Permit Number Cross Reference:
Issue Date: 6/09/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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i Town Hall, 53095 Main Road
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JUDITH T.TERRY `•�� �.� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 4, 1997
Transmitted herewith is a copy of application No. 1756 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Patrick Higgins •
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.
Signatu�e
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Date
OFFICE OF THE TOWN CLERK �,,,,,,,,,,,,,,,,,
'Town of Southold �.�' 011tirC; = l���
Town Clerk Application No./7---
Judith
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Judith T. Terry, ;`' �
Town Hall, 53095 Main Road < - Construction
P. O. Box 1179 ; � _ �
Alteration
Southold, New York 11971 ;cls
Tele hone 1...0c%, 0- $10.00 - Residential
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(516) 765-1801 = Ol st,, $25.00 -Non-Residential
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TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE "('�� ( 7
APPLICANT NAME:
APPLICANT ADDRESS: C'� , / '
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SEPTIC CESSPOOL !/'
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUSq ONORR ALT RATION:
OWNER OF PROPERTY :
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OWNER MAILING ADDRESS: . 0 -
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OWNER PROPERTY ADDRESS: t
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TELEPHONE NUMBER OF CONTACT`LPERSON:
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TAX MAP NO. : Section Y BlockS Lot
CROSS STREET : �D '-'4
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature Of7/7-=
icant
RECEIVED BY:
o n C e 's Office
DATE: 0, C�
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