HomeMy WebLinkAboutNovick, Samuel X00
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JUDITH T.TERRY s ?` Town Hall, 53095 Main Road
TOWN CLERK y Z 1 P.O. Box 1179
Vb. P Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �\ O Fax(516) 765-1823
MARRIAGE OFFICER �-y4. O.,i�
RECORDS MANAGEMENT OFFICER .( .#is" 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. 1561 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 LINES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner NOVICK, SAMUEL
Mailing Address 1 11 SORGI COURT
City St Zip PLAINVIEW NY 11803
Property Address 1 3670 ROCKY POINT ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 21 .00 block 4 lot 5.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 11/01/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �' y1 Town Hall, 53095 Main Road
TOWN CLERK % y i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O �1�, Southold,New York 11971
MARRIAGE OFFICER � y 0 �1 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER `4Ol iNgTelephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,414°�I,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 21, 1996
Transmitted herewith is a copy of application No. A1625 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Samuel Novich
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.
O cola )
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.
•
Signature 1
/.°,97,46;
Date
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OFFICE OF THE TOWN' CLERK 0,'"""
Town of Southold �0."c)tf Ull-
Judith T. Terry, Town Clerk 1,%'Q, �l/'.-..i. :
% Application No.
Town
Town Hall, 53095 Main Road Z �C ? Construction L/
P. O. Box 1179 • ' ` Alteration
Southold, New York 11971
Telephone a,��� ��O,s' $10.00 - Residential (/
(516) 7 65-1801 _ 1
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 I/69/a/ __________
APPLICANT NAME: e./ ,, J
APPLICANT ADDRESS: 7.?10 ,mal 9J 2 �4
.00", ...., -Or: ' -- - _ii._-_r _
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION(• (.. /.--72-1-11--
-7---C , 61" i-.. w .[,.
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: /4 4 6/4-'i
OWNER PROPERTY ADDRESS:_ j 7 7 8.-14_,e--z(4,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ( I Block q �- Lot j
CROSS STREET : — j .- 5.—.
BUILDING PERMIT NUMBER CROSS REFERENCE:
44 l
— ignature App icant
RECEIVED BY:
Town Clerk's Office
DATE:
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