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HomeMy WebLinkAboutWennerholm, Edward o, \O co ELIZABETH A.NEVILLE �`1 y • Town Hall, 53095 Main Road TOWN CLERK `p -� P.O. Box 1179 Z Southold, New York 11971 • REGISTRAR OF VITAL STATISTICS • v' MARRIAGE OFFICER • 6° 4 Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER #*0� 4.0\' Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER W • ot" OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1824 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 WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner WENNERHOLM, EDWARD & MONICA Mailing Address 1 40 TRAFALGAR SQUARE City St Zip LYNBROOK NY 11563 Property Address 1 650 BAYVIEW AVENUE City St Zip SOUTHOLD NY 11971 Tax Map No. section 52.00 block 5 lot 42.000 Cross Street COLONY ROAD Building Permit Number Cross Reference: Issue Date: 3/13/98 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) Ire •• ,„, g�FFO(,-c O ELIZABETH A. NEVILLE Town Hall, 53095 Main Road TOWN CLERK � t P.O. Box 1179 � c y Z Southold, New York 11971 •REGISTRAR OF VITAL STATISTICS • v' /�t Fax (516) 765-1823 MARRIAGE OFFICER �OyO �aOd1 Telephone (516) 765-1800 RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER a.. •-• OFFICE OF THE TOWN CLERK M TOWN OF SOUTHOLD D J ^f 1 rare I ) ?! TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office ELM= Pi-PT DATED: March 11 , 1998 Tp‘4✓'o f' `� `T`"' ?;'__ Transmitted herewith is a copy of application No. „1-19-9-6— for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Edward & Monica Wennerholm 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 follow'ng recommendation: APPROVE - DISAPPROVE - COMMENTS: Maintain required setbacks from adjacent wells, buildings, property lines and water bodies. EXCAVATION INSPECTION REQUIRED. "54gnat r 31 ` 30&- Date OFFICE OF THE TOWN• CLERK ��000. ,, Town of Southold ���'i Cj�FFOtK`'0 = Application No/�g� Judith T. Terry, Town Clerk �� G� Town Hall, 53095 Main Road ; ae : structio- C� ti.. P. O. Box 1179 % = rn ; Iteration Southold, New York 11971 ;� �� �� Telephone • =y0,, ,��r�; $10.00 - Residential__ _ '� - P 1 1 lr (516) 765-1801 = � �,r $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 5/3//i.______________ APPLICANT NAME: _ ,-e--C- _ .. �-_. �_-------------_._-_ APPLICANT ADDRESS: Piz i ' •-,6 92z..., ___ .__� `_ SEPTIC CESSPOOL .0.7 DESCRIPTION SOF PROPOSED CONSTRUCTION OR/ALTS AT ON LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION : OWNER OF PROPERTY : ,.r1„1, -41-4, A(-eA-A14-A-- -eis,- OWNER MAILING ADDRESS:__ -V�' � , i �> G, /456;3 OWNER PROPERTY ADDRESS:_ Tri.";;:ci-P-te---s-L,-- f.jt-°-4- lv•k, /19 7( TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section .69.. _Block____5 Lot Y� GAS STREET: _�__�_ L'©hMJ f-- 4 / BUILDING PERMIT NUMBER CROSS REFERENCE: • I''Ot°-PAi 1 Signature of Applic RECEIVED BY : Town Clerk's Office v DATE: • /," I I C'-s' /frL r ' obi hog' eiL? rim,mid c,eivov � sIft