HomeMy WebLinkAboutRosenberg, Peter iff
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ELIZABETH A.NEVILLE,RMC, CMC �11I��� 0
4 Town Hall, 53095 Main Road
TOWN CLERK * * , P.O. Box 1179
cn Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G Q �� Fax(631) 765-6145
MARRIAGE OFFICER AZ ��
RECORDS MANAGEMENT OFFICER � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER Oy0O�1Y11i* IIS�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. 3896 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE INC
Address 1: 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTH,f. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner PETER ROSENBERG
Mailing Address 1 22035 SOUNDVIEW AVE
City St Zip SOUTHOLD NY 11971
Property Address 1 22035 SOUNDVIEW AVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 135.00 block 1 lot 12.000
Cross Street CLARK ROAD
Building Permit Number Cross Reference:
Issue Date: 9/09/09 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE,RMC,CMC �� ��� yO4 Town Hall, 53095 Main Road
TOWN CLERK ; * , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS c Southold, New York 11971
MARRIAGE OFFICER aOQ��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICERTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - COU , ."I, southoldtown.northfork.net
... .
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ppfECE11V. E .
TO: Southold Town Building Department E AUG 3 1 2009
FROM: Carol Hydell, Southold Town Clerk's Office BLDG.DEPT.
TOWN OF SOUTHOLD
DATED: August 31, 2009
Transmitted herewith is a copy of application No. 3896 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool Rosenberg
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.
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Signature
Vg7r/or
Dated
_ I ,,/iii,
ELIZABETH A.NEVILLE ���`t` D� Town Hall, 53095 Main Road
TOWN CLERK �� p d P.O. Box 1179
a Southold New York 11971
REGISTRAR OF VITAL STATISTICS O Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ' \4#041 ao ,��' Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER = '� * ,. southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
• APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 //or Non-Residential @$25 Application No. VC°
Permit No.
- - Applicant Name /Pa S OjrfP,°/ L :12C—
Applicant Mailing A dress 76ef^/1/�. C'ul/` ,,
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration /-<.) -.)-27a4fier-i2
•
Location of Proposed Construction/ ration:
Owner of Property: ( i/Afl /oT,niJ )7
Owner Mailing Address:
Owner Property Address: 2 2 o.1 r G91- e
( r 61/1/' 7(
Name and phone number of contact person ,7‘r- _ gab
Tax Map No: Section - C ) Block / Lot
Cross Street C,C�fX-k
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received by: •; � •
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