HomeMy WebLinkAboutWickham, Parker S.
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JUDITH T.TERRY t, �� Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
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:� i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER #40 �. •S Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER .� `�►�� �� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER i�s.�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1572 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 WICKHAM, PARKER J .
Mailing Address 1 AIRWAY DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 AIRWAY DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 1 lot 1 .000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/26/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
MIO�• / 7
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JUDITH T.TERRY t _ ?1 Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
T Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER :.-me / Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER %--'1491
14%0" Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER 'P'"••~„
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ` 8 j
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 13, 1996
Transmitted herewith is a copy of application No. 1638 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Parker J. Wickham
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.
RECEIVED 4-14;
N OV 2 5 1996 Signature
; V5"P4( // & ° .6
Southold Town Clerk Date
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OFFICE 'OF THE TOWN' CLERK ,�,'",,
Town of Southold �'itticIVO KcoG ' Application No.
Judith T. Terry, Town Clerk ��' �� y � /4 S_-_.
Town Hall, 53095 Main Road ;� Construction �_---_7_
P. O. Box 1179 irn
p ;
New York 11971 : VI W ; Alteration
Southold,
Telephone �;y0,��o ��0�','l� $10.00 - Residential
(516) 765-1801 _ 1 'i
i '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 ///t2..\/
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APPLICANT NAME: « _ w�`, mss./
APPLICANT ADDRESS: ,J. e 922..— y�
-_,/-- )1 • y _ / 5S--2
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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eg..„...... ...--,-,_‘ r (-2/172-,4 ,--- .....,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTIO OR ALTERATIbN:
OWNER OF PROPERTY: /tr.1, .."
OWNER MAILING ADDRESS: 1-0 A .
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: al-.9j 9 6 5-2'
TAX MAP NO. : Section Pr-3, Block / Lot ( _
CROSS STREET: '22,. ..11 gitHic—et a,z(__. ‘
BUILDING PERMIT NUMBER CROSS REFERENCE:
____ ____041 /
Signature •f Applican
di
RECEIVED BY :
Town Clerk's Office
DATE:
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