HomeMy WebLinkAboutMikelbank, James ELIZABETH A.NEVILLE $ `Z4 Gy�A Town Hall, 53095 Main Road
TOWN CLERK c -� P.O. Box 1179
• •
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • +'
O 417 Fax (516) 765-1823
MARRIAGE OFFICER � 1i
RECORDS MANAGEMENT OFFICER #* Alk
Telephone� 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. 1816 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 MI KELBAN K, JAMES
Mailing Address 1 3190 PARK AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 3190 PARK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 8 lot 20.001
Cross Street MARRATOOKA AVENUE
Building Permit Number Cross Reference:
Issue Date: 2/23/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE 1�`Z`� �G. �` Town Hall, 53095 Main Road
TOWN CLERK % p -�% `P.O. Box 1179
• y 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • 1+' t
MARRIAGE OFFICER . 4 �� • Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER ����! ��� °/ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 0,..
A, l
E C E 0 V E
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department BLDG,DEPT,
FROM: Linda Cooper, Southold Town Clerk's Office II 'F .
FROM: ,, $
DATED: February 20, 1998
Transmitted herewith is a copy of application No. 1890 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for James Mikelbank .
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.
2 eLd�
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the follow' g recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
s
ignature
Date
0-:10FlitE OF THE TOWN• CLERK ,,''' '1
Town of Southold '01 �FFD(�`'
Judith T. Terry, Town Clerk ;'x,Z, Ol/y� Application No. /6
Town Hall, 53095 Main Road ; if ...4. ;• C• • . on
P. O. Box 1179 ; A �T,
Southold, New York 11971 .Vs W / Alterat on���-
Telephone =`04„. �,%. ��,r $10.00 - Residential v
(516) 765-1801 - �1 r
�� , � $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---_ . __.___ ATs .__-_,_._-.--_-___-
/2$
APPLICANT NAME: _,
. .64......",--e
APPLICANT ADDRESS: Pi fl-A17‘ _97
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: . ,.' u , % • i Q2S
OWNER OF PROPERTY :
OWNER MAILING ADDRESS: x/99 69.9-4-,< /7Gt
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ol /.d"_ %,,s-SS
TAX MAP NO. : Section_ /0 3_ _Block O Lot p7
CROSS STREET :-__ j M27/e/2-0 7`� , ,QA-' n":7-
BUILDING
":BUILDING PERMIT NUMBER CROSS REFERENCE:
___01‘4-1--24 Signature of App cant _
RECEIVED BY :
rk's Office
DATE:
FEB 2 T 1998
P.,luthoid Town C6srt
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