HomeMy WebLinkAboutDrum, Henry /#„
OFFOUr
ELIZABETH A. NEVILLE ���1�� y- `• Town Hall, 53095 Main Road
TOWN CLERK 4 H Z P.O. Box 1179
•
REGISTRAR OF VITAL STATISTICS
6 Southold, New York 11971
MARRIAGE OFFICERN.4*
� �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _y�19 ,
l * �►O���, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER — ,•s"e 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. 3236 R Residential X Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: P 0 BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
REPLACE OLD POOL (CAVED IN) WITH NEW TYPE PRECAST
APPROVED MAINTAIN RECQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS,
PROPERTY LINES & WATER BODIES
'lame Of Owner DRUM, HENRY & MARY
Mailing Address 1 2615 EAST MILL ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 SAME
City St zip 0000
Tax Map No. section 100.00 block 3 lot 17.000
Cross Street GRAND AVE
Building Permit Number Cross Reference:
17 All 4
1
Issue Date: 1/26/05 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �� ` Town Hall, 53095 Main Road
TOWN CLERK • y Z • P.O. Box 1179
REGISTRAR OF VITAL STATISTICSD ��� Southold, New York 11971
MARRIAGE OFFICER y Q��1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER , ilig **,,01 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
5 eR4 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 5, 2004
Transmitted herewith is a copy of application No. 3378 for a Cesspool/Septic Tank Construction
Permit submitted by:
Henry & Mary Drum
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:
Signature
S d'r4u
Dated
OFt7CK OF THE TOWN CLERK ��i c`t�f of b/�..'
TOWN OFSOUI171OLD �� ��/ CO.^ Application No. 33
N1JZAB1ffH A.NEVBdB,TOWN CLUNK � �/ •
P.O.BOX 1179 Construction U
cf."
SOUPLOtD,NEW YORK 11911 T
�. Alteration
Telephone Vo ��Q•��•', $10.00 - Residential (/'
(631) 765-1800 - 1 4 ,p•� $25.00 -Non-Residential
• ". ..i,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE to I ! b
APPLICANT NAME: PECON 1 C CESSPOOL.
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
, L/e"f-c—4 it-esep-- CdA Pot, ✓.c✓) cilLte +p-ate
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /L2 # / p /tti.ul
OWNER MAILING ADDRESS: (9j /S W'/ (7" A4,4/ J
4 f --
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER C = CONTACT PERSON: 6:4.f -14
SV
TAX MAP NO. : Section ( U'n Block 3 _Lot
CROSS STREET: 6014•-C_. .
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of A licant
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,.-- Henry Drum
2615 East Mill Road
Mattituck