HomeMy WebLinkAboutWells, Jim o�soFFot,��o
ELIZABETH A. NEVILLE _� G�� Town Hall, 53095 Main Road
TOWN CLERK y i P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS 0_0 Southold,Southold, New York 11971
MARRIAGE OFFICER ,L Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 7�,� �a� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3111 R Residential X Non-Residential
Fee $ 10.00 septic x Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: PO BOX 972
City St zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTINO REQUIRED.
Name Of Owner WELLS, JIM
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Mailing Address 1 325 HOWARD AVENUE
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City St zip MATTITUCK NY 11952
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Property Address 1 325 HOWARD AVENUE
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city St zip MATTITUCK NY 11952
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Yax Map No. section 113.00 block 11 lot 7.000
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Cross Street WESTPHALIA ROAD
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Building Permit Number Cross Reference:
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issue Date: 1/29/04 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �`Z` �G.y Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
C* 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1v �!
MARRIAGE OFFICER Gy • !'F Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �a� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
JuL 2 2 2OQ3 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 17, 2003
Transmitted herewith is a copy of application No. 3198 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Jim Wells
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
* * * * * * * * * * * *
I have reviewed the application and loc tion map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Of
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Signature
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Dated
i \ ,
omCE OF THE TOWN CLERKp.
TOWN OFBOUMOLU �9�E��`kCQG Application No.,3
ELIZABBTH A.NBVILLE,TOWN CLERK
P.O.BOX 1179 F Construction (�
sovrHotn,NEW YORK 11971 Alteration
Telephone O,j �Q`C $10.00 - Residential
(631) 765-1800 jot� $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 -7 I5 0
APPLICANT NAME: PEQONIC CESSPOOL
APPLICANT ADDRESS: P. o . BOX 972
MATTI'1'UCK , NEW CORK 11952 '
SEPTIC CESSPOOL v'
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:_
OWNER MAILING ADDRESS: 3A
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERS ON:_____� '�1C�58
TAX MAP NO. : Section---J/ 'j Block_ Lot to 7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED
Signature 0 Applicant
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FILE No. 745 FILED MAY 10,
1921
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TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C, TAX No. 1000—1 13—1 1 —07
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OCTOBER 26, 2002
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