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Home My WebLink AboutFujita, David s • I SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3305 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : DAVID FAJITA Address 1: 20 MECHANIC STREET City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration ALTERATION/ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner FAJITA, DAVID Mailing Address 1 20 MECHANIC STREET City St Zip SOUTHOLD NY 11971 Property Address 1 20 MECHANIC STREET City St Zip SOUTHOLD NY 11971 Tax Map No. section 61.00 block 4 lot 32.000 Cross Street MAIN ROAD Building Permit Number Cross Reference: Issue Date: 5/18/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) �,,,% c SOt'4, , 33 s� ELIZABETH A. NEVILLE , .‘z0 lQ Town Hall, 53095 Main Road TOWN CLERK 4 , P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N �r Southold, New York 11971 MARRIAGE OFFICER Fax 1�� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER tel'. �1 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER COU ,� ,,�' southoldtown.northfork.net ,l ° OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD --- f.1 rc TO: Southold Town Building Department !; NM 200!; I ;J it I FROM: Linda J. Cooper, Southold Town Clerk's Office �. DEF. 01 5^' TNO DATED: March 30, 2005 Transmitted herewith is a copy of application No. 3449 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Morris Cesspool/David Fujita 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: Maintain required setbacks from adjacent wells, buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. �/ Si ature 03 o as— Dated • l�lO CO #111 SUFFOit ELIZABETH A.NEVILLE ��t�`1` 4 Town Hall,53095 Main Road TOWN CLERK i - P.O.Box 1179 REGISTRAR OF VITAL STATISTICS ts• Southold,New York 11971 MARRIAGE OFFICER 'W 1 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��i�� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER `' �' •'1 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. 31{y c Permit No. Applicant Name / 0� f atkefr, Applicant Mailing Address ?60 eare,,e--40-ite-eir-71 Septic Tank or Cesspool^ Brief Description of Proposed Construction or Alteration Location of Proposed Construction/Alte tion: Owner of Property: �/�1/�'' Ft t/9-- Owner /9-Owner Mailing Address: O r Owner Property Address: Name and phone number of contact person 7 ."7-1.7.00 Ae9 Tax Map No: Section l Block ci Lot ___F2 Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL pc9 4 Signa a of Applicant Date Received by: . � 1 � 7 eZe, 7— C ( L��