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HomeMy WebLinkAboutRussell, Scott it*ca. Ski• -- • ••' o ELIZABETH A.NEVILLE ��� '`�y> l01 Town Hall,53095 Main Road TOWN CLERK alli P.O. Box 1179 �„� Southold, New York 11971 REGISTRAR.OF VITAL STATISTICS G � MARRIAGE OFFICER '% — Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER � -(4- u �A ••� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER OVI1rV 1�, •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. 3365 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1: P. 0. BOX 972 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration -REPLACE OLD CESSPOOL WITH NEW TYPE -MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION REQUIRED Name Of Owner SCOTT RUSSELL Mailing Address 1 P. O. BOX 547 City St Zip CUTCHOGUE NY 11935 Property Address 1 515 OAK STREET City St Zip CUTCHOGUE NY 11935 Tax Map No. section 136.00 block 29 lot 1.000 Cross Street HARBOR LANE Building Permit Number Cross Reference: Issue Date: 9/28/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) „ r r„,... �• �pF SO j16 ELIZABETH A. NEVILLE e 1, \ Town Hall, 53095 Main Road TOWN CLERK 4g ; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS i4c. Southold, New York 11971 MARRIAGE OFFICER � �Q 1�, Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �lv ��� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER .v CQU ,� ���� southoldtown.northfork.net 2 2 2005 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD L. TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: September 20, 2005 Transmitted herewith is a copy of application No. 3511 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Scott Russell 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. 7/7447 i.‘t Signature 2-2 Adios” Dated • a OM%Or=WW1 CLARK ,��' l 3 TOW!<VOPpO'010LD ,�'' • " °� .. Al,l�licatlou No. ZA8811t A MILLI CUM ` '° • U� P.O.BOX 1179 SOUI110LD,NSW YORK 11911 u. (1u Residential Telephone : . ��( '�►�O"�� (631) 765-1800 ' 1 1 .1111 lion Residential TOWN OF SOU Hit)! I) SOUTHOLD WASTEWATER 01`;I'trSAI DIS IU11I APPLICAT It./14 for CONSTRUCT ION or ALI t:I:A I 'MI PI MI I SEPTIC TANK or Ct:SSI'1111I. Permit No. 991_07) Fee .$ DA I 1: 6./01.. APPLICANT NAME: PECONI C: CESSPOOL APPLICANT ADDRESS: P. 0. BOX 972 MATT NEW YORK 11152 SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit way he issued. LOCATION OF PROPOSED CONSTRUCTION OR ALi'l RATION: , OWNER OF PROPERTY : 5 O //1 RU594-1/ OWNER MAILING ADDRESS: Rd /' C S7 CU�� � fl✓ �-' // g35- OWNER PROPERTY ADDRESS: 'S� O,qA .S ' -- TELEPHONE NUMBER OF CONTACT PERSON "3/ ;TAY MAP NO. : Section /3 Cr block c q 1 o CROSS STREET: ,C.�j,A__17 ylu BUILDING PERMIT NUMBER CROSS REFER ICI : iecoer_4�� \ Siyl a;it.o e of Al )ficarlt RECEIVED BY: .451/617) Town cler is_0 ice - - DATE: -DATE: Town Of Southold • P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 09/20/05 Receipt#: 9005 Transaction(s): Reference Subtotal 1 1 Septic Permit-Construct- Resid. 3511 $10.00 Check#: 9005 Total Paid: $10.00 Name: Peconic, Cesspool P 0 Box 972 Mattituck, NY 11952 Clerk ID: LINDAC Internal ID:3511 SCOTT RUSSELL 515 OAK STREET CUTCHOGUE ins ----— k- 5 ;// ,Lt d .lg! 'Il / Z - -