HomeMy WebLinkAboutTully, Paul SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION CR. ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3311 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : COASTLINE CESSPOOL
Address 1: 4225 BRIDGE LANE
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
ALTERATION/ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS ERCM ADJACENT WELTS
BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner TULLY, PAUL
Mailing Address 1 143 WICKHAM ROAD
City St Zip GARDEN CITY NY 11530
Property Address 1 2460 PARADISE SHORES ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 80.00 block 1 lot 7.001
Cross Street PRIVATE ROAD
Building Permit Number Cross Reference:
Issue Date: 5/18/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK l�[, P.O. Box 1179
REGISTRAR OF VITAL STATISTICSN �r Southold, New York 11971
MARRIAGE OFFICER � Fax���, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �1 Telephone (631) 765-1800
FItEEDQM-OF'INFORMATION-OI ICER ` IC�U ,*,,e� ' southoldtown.northfork.net
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A U OFFICE OF THE TOWN CLERK
' TOWN OF SOUTHOLD
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TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 8, 2005
Transmitted herewith is a copy of application No. 3456 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Paul Tully (Danny Mackey renting) work by Coastline Cesspool
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.
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Signature
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Dated
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ELIZABETH A. NEVILLE �h`Z` .y Town Hall, 53095 Main Road
TOWN CLERK p •
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � j, Southold, New York 11971
MARRIAGE OFFICER : �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER = �fo a0vr, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = .' * •rr 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.
Permit No.
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Applicant Name 9l - — Le.) e: Cb:sg e0L
Applicant Mailing Address ,�rAe, Vad S ,(Qid 66 4-4-)
CaTcHC'61f—
Septic Tank or Cesspool ✓�
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: �9X�
Owner Mailing Address: ,,e;e- se- 5�,r0j
5,�•/,�,irk
Owner Property Address: 6 iieO P(11.13,4 rs E S D
Name and phone number of contact person ` //lx „,444-
Tax
Tax Map No:/40 Section OSQ Block 0/ Lot 7,
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY W . IEALT DEPARTMENT APPROVAL
Signature of Applicant Date
Received by:
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