HomeMy WebLinkAboutKelsey, William ►
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ELIZABETH A. NEVILLE ''••O ' ) Town Hall, 53095 Main Road
TOWN CLERK , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS d� Southold, New York 11971
MARRIAGE OFFICER �p,�,, Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER COU �`" i 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. 3332 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: PO BOX 972
City St Zip MATTITUCK NY 11952
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.
IXCAVATION INSPECTION REQUIRED.
Name Of Owner KELSEY, WILLIAM
Flailing Address 1 PO BOX 405
City St Zip MATTITUCK NY 11952
Property Address 1 4000 PECONIC BAY BLVD
City St Zip LAUREL NY 11948
Tax Map No. section 128.00 block 6 lot 2.000
Cross Street DELMAR DRIVE
Building Permit Number Cross Reference:
Issue Date: 7/08/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE t � lQ Town Hall, 53095 Main Road
TOWN CLERK 4 4, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N y� Southold, New York 11971
%,„ A,— �1, Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER o Telephone (631) 765-1800
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FRE ® F(sINF,a,RMATION OFFICER ITCOIJNTi/I1° southoldtown.northfork.net
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.0 _ 6 as I OFFICE OF THE TOWN CLERK
I j p TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 3, 2005
Transmitted herewith is a copy of application No. 3475 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Bill Kelsey,John Neely and others
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.
91rit"
Signature
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onus OFTIM TOWNCLERK ��' �1CSF a 7S
-
TOWN
TOWNOTsovmOLD Application No. 3�
ELIZABBTH A.NBVILLH,TOWN CW(K •
P.O.BOX 1179
Construction
SOUTHOLD,NEW YORK 11971 i 0
Alteration
Telephone 0 �Qc .', $10.00 - Residential L/
,
(631) 765-1800 = "'�' 4 , �' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT"
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DAT � 6_ (,
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952
SEPTIC CESSPOOL C/
DESCRIPTION OF 'ROPOSED CONSTRUCTION OR ALTERATION,
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUC ION OR AL !::RATION:
• TION.
OWNER OF PROPERTY:/64,s
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OWNER MAILING ADDRESS: 9 "377e
OWNER PROPERTY ADDRESS: ' 10190 / v ,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /24/ Block (9G Lot 2----
OSS STREET: Gets
BUILDING PERMIT NUMBER CROSS REFER' !-CI_-::: Q
Signature of App ' ant
RECEIVED BY:
Town C erk's Office
DATE: - j -
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William Kelsey, John Neely, etal
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4000 Peconic Bay Blvd.
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