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HomeMy WebLinkAboutWitherspoon, John SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3318 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1: PO BOX 971 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration .ALTERATION/ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FRCN ADJACENT WELLS BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner WITHERSPOON, JOHN F Mailing Address 1 PO BOX 758 City St Zip SOUTHOLD NY 11971 Property Address 1 235 ANDERSON ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 54.00 block 1 lot 10.000 Cross Street SOUNDVIEW ROAD Building Permit Number Cross Reference: Issue Date: 5/18/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) 0. 1 1 •,,•�1''oF so�j= 33 I S ELIZABETH A. NEVILLE I '4 y4 ; Town Hall, 53095 Main Road TOWN CLERK ;t 4 4 1 P.O. Box 1179 REGISTRAR OF'VITAL STATISTICS It C/2 Southold, New York 11971 MARRIAGE OFFICER : �O�i Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �����, '•l Telephone (631) 765-1800 FREEDOM OF,_INFORM4TION•OFFICER = COUNT`t I° _ i_ , ',� southoldtown.northfork.net OFFICE OF THE TOWN CLERK \h't I U i # f TOWN OF SOUTHOLD Tom;-----fs�r Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: April 29, 2005 Transmitted herewith is a copy of application No. 3463 for a Cesspool/Septic Tank Construction Permit submitted by: Peconic Cesspool for John Witherspoon 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: 9.444.6 �..� . ;. / r� Signature Date OFF a OF THE TOWN CLERK •I• COM* T .OWN OF 60V171OLD .,�'�QJ�I CQ .... = Application No. �i,3 ELIZABETH A.NEVILLE,TOWN CLERK � 1 Construction v- P.O.BOX 1179 . /.... SOLTIIIO1D,NEW YORK 11971 v r. „.131 Alteration cn Telephone '----4.4V Dij� �QFr�'r $10.00 - Residential i/ (631) 765-1800 = �l' 'r >� ,�r $25.00 - Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT ' APPLICAT ION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee .$ DATE 0 y f o'�110_1-- ' ',©• APPLICANT NAME: PECONIC CESSPOOL APPLICANT ADDRESS: P. 0. BOX 972 MA`II'ITUCK, NEW YORK 11952 ' SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONST UCTION ORA TLRATION: • . OWNER OF PROPERTY: F � OWNER MAILING ADDRESS: ,y 1 it . 1?e ' er 1S e `,v--te- a OWNER PROPERTY ADDRESS: 9.23S -y,,, JL.a. TELEPHONE NUMBER OF CONTACTttPERSON: TAX MAP NO. : Section 5 ''T . Block I Lot ID. CROSS STREET: g D .4-.4k BUILDING PERMIT NUMBER CROSS REFERS ICE:: a -- . ' _ _ ___A1-,. A___ - . 1 .di Signature of A icant RECEIVED BY: � ��V Town Cerk's Office DATE: � ti, isj . • , . i • • "" k . •A • __:....ti 2 '27)5' 04A-41S46., v—k.. •Ses....,C4.1j-tit*<, C 1 JOHN WITHERSPOON 235 ANDERSON ROAD ) SOUTHOLD .' 44— r. I , \------- IA; .__ ....--,- .... ‘ ! -\{ . I . 1 1-,,,,- er r , rk) 01/41 ti' TiveP I 1 4._ - , C 1 1 .., I \..t /, 1 ii4/1\I 1 b \ t:t J