HomeMy WebLinkAboutWitzel, John ;o011rchq,�
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i ' Town Hall, 53095 Main Road
0$ Si / P.O. Box 1179
1o,% "K/ .�V Southold, New York 11971
JUDITH T.TERRY �`•1� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1590 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 WITZEL, JOHN
Mailing Address 1 4635 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 4635 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 137.00 block 4 lot 6.000
Cross Street STILLWATER AVENUE
Building Permit Number Cross Reference:
Issue Date: 1/16/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �•
1y1 Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘1441
t Southold, New York 11971
MARRIAGE OFFICER ��
IS Fax(516) 765-1823
�1J ,��� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER I `�►
FREEDOM OF INFORMATION OFFICER ..... po
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department `t .,
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: January 14, 1997
Transmitted herewith is a copy of application No. A1659 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for John Witzel
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.
RECEIVED
JAN 15 1997 Linda J. Cooper
3 : � ✓ * * * *
Southold To avrrel 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.
12
Signature 0-1� 1-14
Date
/A1971`1 97'
OFFICE OF THE TOWN' CLERK ,,,'""" %,
Town of Southold ,41"e_ FFOtkC
/6,57f
Judith T. Terry, Town Clerk Application No.
Town Hall, 53095 Main Road Construction
P. O. Box 1179 am ` Alteration
Southold, New York 11971
Telephone
'WO/ �� . $10.00 - Residential L— _
(516) 765-1801 _ � ' $25.00 - Non-Residential
• I, _�____--
TOWN OF SOUTHOLD'
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 1 `\1 _ -, l C (I 7
APPLICANT NAME: j, Ar.f
APPLICANT ADDRESS: /� d 97-
l - 21.y
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
* ,1"
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCT' N OR ALTERAT ON:
OWNER OF PROPERTY: " '? -
OWNER MAILING ADDRESS: 6
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER NUMBER OF CONTACT PERSON: � �{ ?6 Sr-7
TAX MAP NO. : Section / s 7 Block '17( Lot 6
CROSS STREET: 14 v
BUILDING PERMIT NUMBER CROSS REFERENCE:
R#///
Signatur of Applicant
RECEIVED BY: 8Z if
c,� Town Cler s Office
DATE: / l// fr �'
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