HomeMy WebLinkAboutRogers, Douglas 0,0S�FFO��-�0
JUDITH T.TERRY ��� Gy1 Town Hall, 53095 Main Road
TOWN CLERK y = P.O. Box 1179
rn i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS •
MARRIAGE OFFICER , y ���, Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER `'o 1O� 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. 1537 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 RO8ERS, DOUGLAS AND SHARON
Mailing Address 1 OLD ORCHARD LANE
City St Zip EAST MARION NY 11939
Property Address 1 OLD ORCHARD LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 6 lot 22.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 9/16/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
o,I
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ; y = P.O. Box 1179
$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
,j Fax Fax (516) 765-1823
MARRIAGE OFFICER =;4c, *7060.
4 r�� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER . J [ ��6
FREEDOM OF INFORMATION OFFICER ..0.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: September 5, 1996
Transmitted herewith is a copy of application No. 1603 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Douglas and Sharon Rogers •
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.
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Signature
Date
OFFICE OF THE TOWN CLERK ,,,'"'"
Town, of Southold it�5�' �Ff01� _ //
Judith T. Terry, Town Clerk ,' C�Gy Application No./k.
Town Hall, 53095 Main Road _ Construction (�4
P. 0. Box 1179 Alteration
Southold, New York 11971 Z,Fri —Telephone $10.00 - Residential (/ r_
•
(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
�. JJ
APPLICANT NAME:
APPLICANT ADDRESS: PP, 137N- 97 .
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR LT R : A
OWNER OF PROPERTY: 40-11144.• J(�
OWNER MAILING ADDRESS: Q Q✓l.�L �y.�--rC - __
( A240. ?i- /1/4--
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:c:r�y
TAX MAP NO. : Section 3, Block (' Lot
CROSS STREET : kt
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY:
Town Clerk's Office DATE:
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