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Home My WebLink AboutSmith, William r i' .0 SOUly- ELIZABETH A.NEVILLE,RMC, CMC 1I �� O4 Town Hall, 53095 Main Road TOWN CLERK , P.O. Box 1179 y Southold,New York 11971 REGISTRAR OF VITAL STATISTICS t G Qte MARRIAGE OFFICER • . •1 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �i1 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER =yCOUNTY,nil 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. 3906 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : COASTLINE CESSPOOL & DRAIN SVC Address 1: 4225 BRIDGE LANE City St Zip CUTCHOGUE NY 11935 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner WILLIAM J SMITH Mailing Address 1 P 0 BOX 1238 City St Zip CUTCHOGUE NY 11935 Property Address 1 46530 RTE 25 City St Zip SOUTHOLD NY 11971 Tax Map No. section 75.00 block 3 lot 3.000 Cross Street SOUTH HARBOR ROAD Building Permit Number Cross Reference: Issue Date: 10/06/09 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) I 10111001V°4' �oil'A 0 SO(/ry- ELIZABETH A.NEVILLE,RMC,CMC ��' Ol0 Town Hall, 53095 Main Road TOWN CLERK ; iNg * z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS cs� Southold,New York 11971 MARRIAGE OFFICER : COG. Q � Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 0i Telephone (631) 765-1800 1 FREEDOM OF INFORMATION OFFICER -yC�UIV 1�,� �� southoldtown.northfork.net OFFICE OF THE TOWN CLER ' LS C E O V IE TOWN OF SOUTHOLD OCT - 5 2009 JJ TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office TOWNLDG.OF SOUTHOLD DATED: October 2, 2009 Transmitted herewith is a copy of application No. 3906 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Coastline Cesspool&Drain Svc 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. Thank you Carol Hydell * * * * * * * * * * * * 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. . AO,‘7/ / Oir Signature "-- (0,-4-A- _, G G y Dated ,f V ��'�O�' S\ Town Hall, 53095 Main Road ELIZABETH A.NEVILLE c TOWN CLERK P.O.Box 1179 •.y . Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ‘` 47 Fax(631) 765-6145 MARRIAGE OFFICER y �� 0 Telephone (631) 765-1800 RECORDS MANAGEMENT OFFICER = a�•. southol (6 northf-1800 t FREEDOM OF INFORMATION OFFICER -.. ..go ' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK • Non-Residential $25 Application No. 3936 Residential @ $10 or @ Permit No. Applicant Name OflQ \\" V PP ea \ 1 n `�)C"' cv Applicant Mailing Address ;(7)C k cof \_� Winnr-W) tk,-6 \\ICAL Septic Tank or Cesspools 1\ C1> ��{� Brief Description of Proposed Construction or Alteration 0\3e c-V \cam C,e&SE\. Location of Proposed Construction/Alteration: Owner of Property: i\\\\QrYI ---5- Sc \N-\r Owner Mailing Address:_ 9 D Px_x \ 29 Co-ltc'il ue N \\O‘ Address: LI lr Jv'C-' Owner Property Name and phone number of contact person �1\\- �0_q d -\339 Tax Map No: Section j22 ,Block -7- Lot -1.5.--- -3 Cross Street „S - \ r" C3 . NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES S :VEY WITH HEALTH DEPARTMENT APPROVAL _o 1 i (--- 1 1Q\\\Coq . Signature of Applicant ` - Date fr Received by: IF I M• � 0 • t� f �f 119. • tr `• 7' �` rw Jv • _ i t r 1. � • - ra. - ti 1 • - f l � + L � .�'"r k+t "•> ;ire ._ ! • �'d. • 111 • • • ...„...... ,,.....„4„... ....., „,..„ ,... ..., , ,,,,,,:.,..:„,..,.„: . - -: '� ts, _844ing) '.i , '_toja96 3 r. M— ymay,, , - _ r'- i!• - -s '+ , • • , *, . , a.., .. .... - tet'''