HomeMy WebLinkAboutUry, Arthur n
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g Town Hall, 53095 Main Road
�. P.O. Box 1179
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JUDITH T.TERRY TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR 01 VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1594 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 URY, ARTHUR
Mailing Address 1 3750 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 3750 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 137.00 block 1 lot 12.000
Cross Street TRACK AVENUE
Building Permit Number Cross Reference:
Issue Date: 3/19/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
JUDITH T.TERRY � _ �� Town Hall, 53095 Main Road
TOWN CLERK N i P.O. Box 1179
T Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �Oy '��� Fax (516) 765-1823
1
MARRIAGE OFFICER 4t a0111� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER '�►
FREEDOM OF INFORMATION OFFICER '•v,• �i"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 3 -
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: February 13, 1997
Transmitted herewith is a copy of application No. 1667 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Arthur Ury
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.
b,
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
MAR 1 9 1997 Signature /
Southold Town `"lc'44 Date
f .
OFFICE OF THE TOWN CLERK ,,,'",,,"" ,
Town of Southold �.'�� �FFUTA(`'
Judith T. Terry, Town Clerk �S' �,� - Ol/y Application No. /C7
Town Hall, 53095 Main Road ;�..: • Construction
P. 0. Box 1179 Alteration
Southold, New York 11971 tt� - rn
Telephone --+0 %ry $10.00 - Residential l/'
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(516) 765-1801 '_Ol 4 �, ' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE Q Z �7
APPLICANT NAME: /t2 ) , :4,� A
APPLICANT ADDRESS: Z&. / 972- _
4., -�
SEP`i :C CESSPOOL t/
DESCRIPTION F PROPOSED CONSTRUCTION OR ALTERATION N
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUC ION ALTERATION :
OWNER OF PROPERTY: (117./20_OWNER MAILING ADDRESS: 7 S0 S7 T .�, a��
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OWNER PROPERTY ADDRESS: '-----
TELEPHONE NUMBER OF CONTACT PERSON: a-9e— 96o5V'
TAX MAP NO. : Section / 3 7 Block 7 Lot / �i
C6-S& STREET: e Z ti
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BUILDING PERMIT NUMBER CROSS REFERENCE:
oe.j.7i, i
Signat of Applicant
RECEIVED BY : (t( /(/_,C.4.--id
T n Clerks -Office
DATE: -, -)/// Q,7
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