HomeMy WebLinkAboutMercier, Thomas „,iiia..
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ELIZABETH A.NEVILLE �' 4d\ Town Hall, 53095 Main Road
• TOWN CLERK t CA Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘`‘14 4 1$ Southold, New York 11971
MARRIAGE OFFICER
y 0' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER - 0•i * `j►ole. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ , ,,s” 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. 3271 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
REPLACE OLD CESSPOOL WITH NEW TYPE
MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDING PROPERTY
LINES, AND WATER BODIES. EXCAVATION INSPECTION REQUIRED
Name Of Owner MERCIER, THOMAS
,ailing Address 1 P 0 BOx 1423
City St Zip MATTITUCK NY 11952
Property Address 1 10530 SOUND AVE
City St Zip MATTITUCK NY 11952
-pax Map No. section 122.00 block 2 lot 15
Cross Street FACTORY AVE
Building Permit Number Cross Reference:
Issue Date: 1/27/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE e t` Town Hall, 53095 Main Road
TOWN CLERK CA _ ; P.O. Box 1179
,
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS : O ',
yu 0���� Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER i �l * $I,•' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '•-.,,,..s"i° southoldtown.northfork.net
DEC L Z 20 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 21, 2004
Transmitted herewith is a copy of application No. 3414 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Thomas Mercier
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. .
7 ,//‘....../...-,"‘4.71.5
Signature
D 03/0 s-
Dated
•
*OFFICE OF 11111 1 OWN CLERK 4111G /� �/ (/
TOWN OFSOU111OLU I�1�J���O��`aG Application ation Pio. J//
RUZABIrIll h.NBVILLII,TOWN CLERK
P.O.BOX 1179 Z11~ I .E�i►SI► 1lctlull 1
SOUCIIOLD,NIiWYORK 11971 ; j Alt 't atiE)►1
Z 0 �'~c' f 10.1111 Resiclelltial
Telephone .a t�
(G31 ) 7G5 11100 �•�' �fi )';. 00 IIfm •Rsidel►lial
•• aD
TOWN OF SOU 1111 ►1.1►
SOUTIIOLI) WASTEWATER WADER 1.,1`:11► AI. DI'; I RICA
APPLICATION
for
CONSTRUCTION or ALL [RAI loll I'I:I?A;11 I
SEPTIC TANK or t:ISS11)1)I.
Permit No.
FeeDAI I 11 2` 0 •
APPLICANT NAME: I'I?CONI (' CE1131)001, ,f
APPLICANT ADDRESS, P . o . BOX 972
NAI'TrrUCK , NEW „YORE I Pri2
SEPTIC CESSPOOL t/_
w
DESCRIPTION OF PROPOSED CONSTRUCTION (1k Al.1 I..ItA I ic)11
� , am•
LOCATION MAP: Must be attached hereto helm f I1 'i wit may I)f! k,owd.
LOCATION OF PROPOSED CONSTRUCTION OR AI.FFRA 11011 :
OWNER OF PROPERTY : M-e i "-
OWNER MAILING ADDRESS: Pio t .it I tf 23
M ' t in Us�1S
OWNER PROPERTY ADDRESS f DS 30 S O AV
TELEPHONE NUMBS l OF CONTACT PERSON
4.7 8'8R ��
TAX MAP NO. : Sectio:l Block. Loi
. 5 STREET:
BUILDING PERMIT NU OBER CROSS REI"I_RH D:I : ---�
Signature of ` ,Ialical)t
RECEIVED BY :
I own ( l-o k's Office.
DA I
E:
Thomas Mercier
10530 Sound Avenue
Matti tuck,NY
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Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 12/21/04 Receipt#: 8418
Transaction(s): Subtotal
1 Septic Permit- Construct- Resid. $10.00
Check#: 8418 Total Paid: $10.00
Name: Peconic, Cesspool
P 0 Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID: 102668