HomeMy WebLinkAboutRaacke, Barbara 0,0OFFOL t
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JUDITH T.TERRY � _‘ 'yam 1 Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
%•‘141')w• Rt S Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G
MARRIAGE OFFICER %* . Fax(516)765-1823
RECORDS MANAGEMENT OFFICER .(.j 4) , Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER "••.,, ,s•"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1684 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BARBARA RAACKE
Address 1 : P. O. BOX 816
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM. (WORK DONE BY RAY NINE)
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner RAACKE, BARBARA
Mailing Address 1 P. O. BOX 816
City St Zip MATTITUCK NY 11952
Property Address 1 4055 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 13 lot 18.000
Cross Street BENNETT'S POND LANE
Building Permit Number Cross Reference:
Issue Date: 6/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Crr ( Ca °
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i Town Hall, 53095 Main Road
X04 0 ; P.O. Box 1179
1
111 ► .�y��: Southold, New York 11971
JUDITH T.TERRY �. 1 — TELEPHONE
TOWN CLERK (516) 765-1801
RECIS'IRAR OF VITAL STATISTR'S OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 2, 1997
Transmitted herewith is a copy of application No. 1754 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Barbara Raacke (work by Ray Nine)
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.
tt*1
Linda J. Cooper
* * * * * * * * * * * * *
I
have reviewed the application and location map of the project listed
above and make the followi g recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
RECEIVED _
gnature
JUN 2 1997 I -/ --?
Date
Southold Town Clerk
OFFICE OF THE TOWN CLERK .0„,• "
Town of Southold , �'� c)1 gLKCOI/ Application No. �7S-y
Judith T. Terry, Town Clerk � ..
Town Hall, 53095 Main RoadConstruction s
P. O. Box 1179 v rya , Alteration
Southold, New York 11971 tr's 'W$
Telephone ,j� 11)Q��'� $10.00 - Residential
(516) 765-1801 ' 1 4t �., $25.00 - Non-Residential
(OWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEP I.IC TANK or CESSPOOL
Permit No.
Fee $-------
DATE ...wme,
DATE ,UNE 2. , Cr]
APPLICANT NAME: SkeeA } 4,,AMCKE
APPLICANT ADDRESS: PDfX S1Ce38s5 t:UC3?PML/p41 /1.A4
MA77v TLCK , NY /1951--
SEPTIC CESSPOOL S.
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /ID,d /
'4DD)Tl0/U,41- CSS PcL 7'D T 1E S/NG LC-' cEsspoo L
TpM7 wAS /3UILT !Ta_--- THE f-/O — 't/Eku cESSP)L
TO JQE 2 Pi / / s Amo A DasfE
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : 7Q�}_ GCg-_
OWNER MAILING ADDRESS: _k% _-_gi K p4t7
AvifirauG<<, N / 11�s�
OWNER PROPERTY ADDRESS: L71&55 1/V137-PW/L//4 ROAD
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section r 1 3 Block I Lot I &'
CROSS STREET :___&:7•1 11/4.)C_1 J-5 PO/kin I-AN.
BUILDING PERMIT NUMBER CROSS REFERENCE:
41:Out)
Signature of Applicant
RECEIVED BY : "( L _
To Office
DATE:
Southold Town Clerk
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