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HomeMy WebLinkAboutMercier, Thomas (2) _„ SOUIy- ELIZABETH A. NEVILLE �s'h0 �Q \ Town Hall, 53095 Main Road TOWN CLERK 41 ; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS co Southold, New York 11971 MARRIAGE OFFICER : ► �44&•1 Fax Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �1 Tele hone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ICOU ,�`", • 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. 3336 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : PECONIC CESSPOOL ddress 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 FRCM ADJACENT WELLS BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner MERCIER, THOMAS Mailing Address 1 PO BOX 1423 City St Zip MATTITUCK NY 11952 Property Address 1 10530 FACTORY AVENUE City St Zip MATTITUCK NY 11952 Tax Map No. section 122.00 block 2 lot 15.000 Cross Street SOUND AVENUE Building Permit Number Cross Reference: Issue Date: 7/08/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) WM , 0,„-4,-,.......... 3330 0 AN\c S01/4&— 33300 ELIZABETH A. NEVILLE I 'OlQ Town Hall, 53095 Main Road TOWN CLERK * Jig P.O. Box 1179 REGISTRAR OF VITAL STATISTICS % , Southold, New York 11971 MARRIAGE OFFICER , Fax (631) 765-6145 FRRTANAC IVA NT'OFFICER ... 00 Telephone (631) 765-1800 1 'R'EE O iOF,INFORMAT1O OFFICER N=�0OUN1`1 . 1*‘...° southoldtown.northfork.net %\L 042 � 2005 � , U s ____i OFFICE OF THE TOWN CLERK " TOWN OF SOUTHOLD L....:_r-sn:_` -' -- TO: Southold Town Building Department ,<..___._._.-----._._.______....____ FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: June 17, 2005 Transmitted herewith is a copy of application No. 3479 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. . .214.....,44 ' Signat re 2z as--- ated OFFICE OFT SS TOWN CLERK Is' I OUk ��/ TOWN OF SOUTHOLD 4,,', ` \�9 y-1 Application No. ELIZABETH A.NEVHI.E,TOWN CLERK �7 P.O.BOX 1179 �1 F Z 14 Construction SOUTHOLD,NEW YORK 11971 o T Telephone s - ee .,DO`�o�'�� $10.00 = Residential (631) 765-1800 1' � $25.00 on- es1•errt ,,,i//0� TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ _ DATE e•We APPLICANT NAME: PECONIC CESSPOOL APPLICANT ADDRESS: P. O. BOX 972 MATTITUCK, NEW YORK 11952 SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATIO /v�1 X01_4, LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONS RUCTION OR ALTL:.RATION: OWNER OF PROPERTY: • ,i 0 01 OWNER MAILING ADDRESS: /-,, J , ly / tfg3 OWNER PROPERTY ADDRESS: I © S330 TELEPHONE NUMBER OF CONTACT PERSON: 1:94k- 97 cS9'TAX MAP NO. : Section /2:Z. Block 2 _ Lot /5 CROSS STREET: BUILDING PERMIT NUMBER CROSS REFER- ICE:: t .4 .t• ____ � Signature of A-%plicant RECEIVED BY: I' own e' Office DATE: I THOMAS MERC ER 1 0 5 3 0 FACTORY AVENUE MATT ITUCK 1 2 2-2-1 5 5 I N N7* 1404.4..a. tied • diAt CIA; • \ K._ 101i eh/ .4v /41E"1A''tf%