HomeMy WebLinkAboutKarg, Michael /� •�OS�FFOL4'
�� COG
0 •
ELIZABETH A.NEVILLE ,' y� Town Hall, 53095 Main Road
• TOWN CLERK P.O.vis Z Box 1179
REGISTRAR OF VITAL STATISTICS O 1�, Southold, New York 11971
MARRIAGE OFFICER � ifJ �� j' Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER i l 41 'a,,.� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER „so°. 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. 3265 R Residential x Non-Residential
Fee $ 100.00 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
:NSTALL OVER FLOW TO EXISTING SYSTEM
MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY
LINES AND WATER BODIES. EXACAVATION INSPECTION REQUIRED
Name Of Owner KARG, MICHAEL
mailing Address 1 780 KING STREET
city St Zip NEW SUFFOLK NY 11956
Property Address 1 SAME
city St zip 0000
Tax Map No. section 117.00 block 8 lot 11
Cross Street SECOND STREET
Building Permit Number Cross Reference:
yr,
:Issue Date: 1/27/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OF F 01 Ap
G ,
ELIZABETH A. NEVILLE �, y. y<` Town Hall, 53095 Main Road
TOWN CLERK tt�ia Z P.O. Box 1179
PryREGISTRAR OF VITAL STATISTICS Southold, New York 11971
J MARRIAGE OFFICER ` y l/ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Ol Jig **fp"
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
'��,.•00 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Dec 3 LwK
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 10, 2004
Transmitted herewith is a copy of application No. 3408 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Michael Karg
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 location 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.
9fri.c.ve49,7 )
Signature
6.e..
Dated
a
COMM OF THE TOWN CLERK °'ISO Wire' g�Q
TOWN OF BOV1110LD �'
� OG : Application No.
ELIZABBIllA.NIIVILLII.TOWN CLL'RKet.�� Q ;
P.O.BOX 1119
• Construction 'tt�
SOUTHOLD,NEW YORK 11971
! Alteration
ti
Telephone %/1)
$10.00 - Residential /
(631) 765-1800 ' 1' '�
,,�� $25.00 - Non--Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
DATE o`ele
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952 '
SEPTIC CESSPOOL G'
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: ��+� � 4-X-
•
OWNER MAILING ADDRESS: 7g0 s 7'
AJgt,/, S e /fie
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 1/ 7 Block g( Lot 1/
CROSS STREET: ,U47
BUILDING PERMIT NUMBER CROSS REFERS 'JCL::
Sig!la lure of plicant
RECEIVED BY:
Town Office
DATE: • f L� y
•
• r•
•
•
I' 1 .
$
MICHAEL KARG
) 780 KING STREET
NEW SUFFOLK
f1i,....*o......,,.,.......r--....,—...--..r—r--.....—...--,..r.----------- r, ' . .............
, -4,c1444, 'sr
sr
n LA.-
ci
‘,\I i
I
, 41 f------,
....1.1,..
i
..."''
0
.
VLA-t
/ / 14 1141'v
( \-,
(
\ (
1 1/-1 .t
7.---- ti
4... ,
(\wt-li
mth,/ ...C11-4 /k
! Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 12/10/04 Receipt#: 8440
Transaction(s): Subtotal
1 Septic Permit- Construct- Resid. $10.00
Check#: 8440 Total Paid: $10.00
Name: Peconic, Cesspool
P 0 Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID: 102253