HomeMy WebLinkAboutSacks, Nancy / ,��
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tr JUDITH T.TERRY t$ Gte Town Hall, 53095 Main Road
TOWN CLERK ; y Z t P.O. Box 1179
n7 ,I Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �1 Fax(516) 765-1823
MARRIAGE OFFICER y/f' ON.�1
RECORDS MANAGEMENT OFFICER .( �� 1 Telephone (516) 765-1800
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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. 1630 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 ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner SACKS, NANCY
Mailing Address 1 P. O. BOX 700
City St Zip MATTITUCK NY 11952
Property Address 1 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 4 lot 11 .000
Cross Street MARRATOOKA LANE
Building Permit Number Cross Reference:
Issue Date: 4/17/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
..... eor 000 alt......... 0 3 a
Off' o�
JUDITH T.TERRY I'g� Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
u �i Southold,New York 11971
REGISTRAR OF VITAL STATISTICS O
,j, !��� Fax (516) 765-1823
MARRIAGE OFFICER L * 1
49/
f' Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER „
FREEDOM OF INFORMATION OFFICER ' •1 I
OFFICE OF THE TOWN CLERK '�`' 2 51997
TOWN OF SOUTHOLD
7----..
TO: Southold Town Building Department - : -.
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 24, 1997
Transmitted herewith is a copy of application No. 1702 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Nancy Sacks
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 ommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
/
RECEIVED / '`�''
3 '.3 oPAl gnatu , :
APR 1 6 1997 V/7/f7
+!�qy,�,,pp #�� �n �., Date
f'.' .. '!IlOEd TIWn S !'%`�`?5.
OFFICE Of THE TOWN CLERK ,,,"""•
Town of Southold 0' C., FF�(KC"
Judith T. Terry, Town Clerk �'O� OG� Application No. /76_,2
Town Hall, 53095 Main Road Z
P. 0. Box 1179 Construction Lf
Southold, New York 11971 cors .W • Alteration
Telephone = ,y � ��, $10.00 - Residential
(516) 765-1801 �1 �y,� ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 0 9 /?'7
APPLICANT NAME:
APPLICANT ADDRESS: ee , ,� y%-
SEPTIC CESSPOOL -�+
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALT ATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: (7 A.--014- ?C
OWNER PROPERTY ADDRESS: � �
TELEPHONE NUMBER OF CONTACT PERSON: �-9y6
TAX MAP NO. : SectionV // 5 Block Lot /
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE: 4y
Signature of Appj ant --RECEIVED BY: �e�
�T w CI rk's Office
DATE: 0.3 24../
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