HomeMy WebLinkAboutBoulander, Arthur •
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ELIZABETH A. NEVILLE =,10 G'��: Town Hall, 53095 Main Road
TOWN CLERK ; H Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER y �� �, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER -, 0,� �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. 3147 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 BOULONDER, ARTHUR
Mailing Address 1 104 QUEENS BLVD
City St Zip FOREST HILLS NY 11375
Property Address 1 1150 VANSTON ROAD
City St Zip CUTCHOGUE NY 11935
-;ax Map No. section 111.00 block 4 lot 6.000
Cross Street WUNNEWETA ROAD
Building Permit Number Cross Reference:
Issue Date: 4/15/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
/ OoFFO43
ELIZABETH A.NEVILLE ,�_`Z y4; Town Hall, 53095 Main Road
TOWN CLERK % co P.O. Box 1179
Z
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER `� 1 ���1', Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � ��l ,•
fr,.' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,o°1 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
MAR 52
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 5, 2004
Transmitted herewith is a copy of application No. 3286 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for A. Boulander
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and to tion map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: �+
Iricefet9(
Signature
8 01-0o �
Dated
.
OFFICE TOWN OF
..''.Ig�FFOLkeoG Application No.
TOWN OF SOUTHOLD It Q y ;
ELIZABETH A.NEVILLE,TOWN CLERK �7
P.O.BOX 1179 �,� Construction
SOUTHOLD,NEW YORK 11971 : p rn ; Alteration v�
$10.00 - Residential �-
Tele hone =:WV1
(631-) 765-1800 - ' 4 ,,." $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 03/4/741Y
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952 '
SEPTIC CESSPOOL____
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION ORALTERATION:
OWNER OF PROPERTY: j2 LGc.1`. , O ..-
OWNER MAILING ADDRESS: lD _p1G Cc1,c,e.e.", 6.4).-d•
#A ' /137s—
OWNER PROPERTY ADDRESS: //SO I/4 NS tO/U At/
4.- 1/93c
TELEPHONE NUMBER OF CONTACT PERSON: 63/ 94S
TAX MAP NO. : Section /// Block 5' Lot (o
CROSS STREET: W' /—iZC
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature o Q•plicant
RECEIVED BY: (45
Town Clerk's Office
DATE:
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 03/05/04 Receipt#: 7813
Transaction(s): Subtotal
1 Septic Permit-Construct- Resid. $10.00
Check#: 7813 Total Paid: $10.00
Name: Peconic, Cesspool
P 0 Box 972
Mattituck, NY 11952
Clerk ID: LYNDAB Internal ID:90521
ARTHUR BOULANDER
1150 VANSTON ROAD
CUTCHOGUE
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