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HomeMy WebLinkAboutMinerva, Jane 11.4,# S�FFO(,�CoG JUDITH T.TERRY ���� yl Town Hall, 53095 Main Road TOWN CLERK y = P.O. Box 1179 .y. T $ Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER :45/ O�/'1�� Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER ".( slig 14/ Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICERc01i OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK. or CESSPOOL Permit No. 1519 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 AN OVERFLOW TO AN EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS BUILDINGS, AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED. Name Of Owner MINERVA, JEANNE M. Mailing Address 1 P. O. BOX 1144 City St Zip CUTCHOGUE NY 11935 Property Address 1 26760 MAIN ROAD City St Zip CUTCHOGUE NY 11935 Tax Map No. section 109.00 block 5 lot 2.000 Cross Street HIGHLAND ROAD Building Permit Number Cross Reference: Issue Date: 8/06/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) .„1 istfFot4, JUDITH T.TERRY % _� y< Town Hall, 53095 Main Road TOWN CLERK ; y = P.O. Box 1179 i Southold, New York 11971 REGISTRAR OF VITAL STATISTICS `. MARRIAGE OFFICER =yif' �� 1�' Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER : �•� *1.106Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK rv. TOWN OF SOUTHOLD TO: Southold Town Building Department 9 FROM: Linda Cooper, Southold Town Clerk's Office DATED: July 29, 1996 Transmitted herewith is a copy of application No. 1584 for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Jeanne M. Minerva 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- Date r. OFFICE OF THE TOWN CLERK ,,''",,"'"-- Town of Southold x Application No l ' Judith T. Terry, Town Clerk Town Hall, 53095 Main Road Construction �~ P. O. Box 1179 ; o rim Southold, New York 11971 s cn �'�; Alteration Telephone =c*, NOV $10.00 - Residential (516) 765-1801 _ 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 L APPLICANT NAME: : /Ait: i APPLICANT ADDRESS: / . 7 2 is 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: OWNER OF PROPERTY: - --1--1 /!'J OWNER MAILING ADDRESS: /3 41-14 OWNER PROPERTY ADDRESS: 1.97 D TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section /a Block Cf 5 Lot O Z_ L'-RAS.S STREET : BUILDING PERMIT NUMBER CROSS REFERENCE: 44* r Signat re of Appl' t RECEIVED BY: Town Clerk's Office DATE: /14,14 olgy S I • c_c-sspirv.. ( friefvelite) IL. 114411°4