HomeMy WebLinkAboutGoldman, Sarah (2) ELIZABETH A.NEVILLE /14 y Town Hall, 53095 Main Road
TOWN CLERK 1 CO P.O. Box 1179
Z Southold,New York 11971
REGISTRAR.OF VITAL STATISTICS Prt
`F I� Fax(631) 765-6145
MARRIAGE OFFICER
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RECORDS MANAGEMENT OFFICER Jis a.���
vi°' 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. 3223 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 GOLDMAN, SARAH
Mailing Address 1 480 FRED STREET
City St Zip NEW SUFFOLK NY 11956
Property Address 1 480 FRED STREET
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 4 lot 19.000
Cross Street GEORGE ROAD
Building Permit Number Cross Reference:
Issue Date: 9/02/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
.
OIF 14-c
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ELIZABETH A. NEVILLE :"4 Town Hall, 53095 Main Road
TOWN CLERK P.O.Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O 41$ Southold, New York 11971
MARRIAGE OFFICER y 0 ,1' Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_491 4. ' ',d. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER , ,," southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
AUG ' 2 324 TOWN OF SOUTHOLD
FL :COlVED
TO: Southold-Toyai Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office �'� C 2.A4
DATED: August 12, 2004 Southold Town Clerk
Transmitted herewith is a copy of application No. 3364 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Sarah Goldman
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 location map of the project cited above and make the following
recommendations:
APPROVE ✓
DISAPPROVE
•
Comments: 7P14141#4. "''�
Signature
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Dated
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OFFICE OF TUE TOWN CLERK .•��laf[Lkt+
TOWN OF SOUTHOLD 044,c\�� 49 :11.1Application No.�-Jl2�
oti
t?UZA1113T11 A.NEVILLE,TOWN CLERK •
P.O.BOX 1179 �1Construction `/
SOUTHOLD,NEW YORK 11971 • me
v ^' } Alteration
to
Telephone =�,j� A--,c $10.00 -'Residential I/
(631) 765-1800 - l " $25.00 - Non-Residential
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TOWN OF SOUTIIOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
• CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ t'�
DATE - 144(
• APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
NATTITUCK , NEW YORK 11952 '
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
411
LOCATION MAP: Must be attached hereto before hermit may tie issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
. OWNER OF PROPERTY: G �� ,
OWNER MAILING ADDRESS: rS'j, F;)--e-- .
5,4,eth.
OWNER PROPERTY ADDRESS: /1
TELEPHONE NUMBER C'= CONTACT PERSON:..919 96fr
TAX MAP NO. : Section 1/7 Block (3 5i _ Lot k?
!VItd5S STREET
BUILDING PERMIT NUMBER CROSS RE ERENCE:
Signature of A Iicant
RECEIVED BY: AU •
own an-k's Office
DATE: qe 1 ) 104
SARAH GOLDMAN
480 FRED STREET
NEW SUFFOLK
fiwit A.44
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