HomeMy WebLinkAboutLonk, Rudolf Jr %oF sOUryo
ELIZABETH A. NEVILLE �� ti0 lQ Town Hall, 53095 Main Road
TOWN CLERK 41, P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �` G � Fax(631) 765-6145
MARRIAGE OFFICER °%, -4(&•
O 1�
RECORDS MANAGEMENT OFFICER r Telephone(631) 765-1800
1
FREEDOM OF INFORMATION OFFICER % y0OUNi,� ,,�11 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. 3343 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 FRCM ADJACENT WELLS
BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner LONK JR, RUDOLF
Mailing Address 1 25 MOOSE TRAIL
City St Zip CUTCHOGUE NY 11935
Property Address 1 25 MOOSE TRAIL
City St Zip CUTCHOGUE NY 11935
?ax Map No. section 103.00 block 4 lot 3.000
Cross Street LITTLE NECK ROAD
Building Permit Number Cross Reference:
:_ssue Date: 7/08/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
- 33Lf 3
P . , yon
333
ELIZABETH A. NEVILLE 6 2005 , A O : Town Hall, 53095 Main Road
TOWN CLERK j *, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER G . s' Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER COUP,',,..' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 6, 2005
Transmitted herewith is a copy of application No. 3486 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Rudolf Lonk Jr
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.
iiimark
Signature
7 .2,,os—•
Da
- -
--
--cezzu.4-4"—
I OW N OF SOUTIIOLD , 3yer,6
?
SOUTHOLD WASTEWATER DISPOSAL DIS FR IC I
APPLICATION
for
CONSTRUCTION or ALTERA I ft P4 PERM II
SEPTIC TANK or CESSPOOL
Permit No,
Fee $
DA ! F 4:"4,/a if
APPLICANT NAME: PECON C CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATT I TUCK, NEW YORK 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERA I ION
€2.4e-of '4474-1, 4-47 4f1A-e-r%.,A40-4-,.7
- -
LOCATION MAP: Must be attached hereto before p=4-tnit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR TRAT ION :
OWNER OF PROPERTY : DP/i-
OWNER MAILING ADDRESS: al
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON (-SF
TAX MAP NO. : Section f° 3 Block If tot 3
CROSS STREET: /-c-eretAZ-,"
BUILDING PERMIT NUMBER CROSS REFER CI
Sigialture of Applicant
RECEIVED I3Y :
TOwn Cierk`ii—Offi-Ce
---
%
. .41, 644011---Z21'r-A
r
In fr 0 4;c Tiz.i I
dr, ,----
,s ,
e
L-...--.-.•'"--"'"'.""-*"""" air \ AS
a. N
Cl44 "1
4
\I4As ',i'
. \ i 1-r\ ifid
4 - ...
/6,44/
(1 k
'
(
Itm, 11 refrt-i- ,
i it o F
(4 ,.....„... ...
i earlfrlei
IkU40.0.
...........
Stiii Pril4"" _
i de', tsprit