HomeMy WebLinkAboutMeyer, Sandra '_ a SOO
ELIZABETH A.NEVILLE O : Town Hall, 53095 Main Road
TOWN CLERK 1 * , P.O. Box 1179
cA Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; G Q ,1
MARRIAGE OFFICER . �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER -�ly`, �°�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER OUn 1�, . 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. 3376 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 SANDRA J. MEYER
Mailing Address 1 P.O. BOX 1168
City St Zip CUTCHOGUE NY 11935
Property Address 1 31025 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 2 lot 23.500
Cross Street STILLWATER AVE
Building Permit Number Cross Reference:
Issue Date: 10/18/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
7111116
��, %pF SO(jryo
ELIZABETH A. NEVILLE e ,o l0 Town Hall, 53095 Main Road
TOWN CLERK * lig t P.O. Box 1179
va Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G @
MARRIAGE OFFICER � �► �O 11 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER l 111 Telephone (631) 765-1800
1
FREEDOM OF INFORMATION OFFICER ' COUNT('°"
I southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
4 i;,,
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 4, 2005
Transmitted herewith is a copy of application No. 3523 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool/Sandra J. Meyer
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.
Linda J. Cooper
* * * * * * * * * * * *
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. .
Signature
•Lepos--
Dated
4 .i 4 1 ?o.:,\.'11 XY �Rf;f.'
onmig ,'llUowNcLw s A it
'ttt. q►tigl1uow ��'t \ % ° _ Application No.
B1IZAB81U A.MIMI.%TOWN MURK % •. y
P.O.BOX 1174Construction
S0UIN0ID.NBW YORK 11971 . - I ��
i _ Alteration
Telephone 't`'�'G : ‹c.r'� i u. u0 Residential
(631) 765-1800 = "�' �,�r' $25.00 Non-Residential
..,,, _..__ ___ _
TOWN OF SOUTIIOLDD
SOUTHOLD WASTEWATER DISPOSAL IMS I RId I
APPLICATION
for
CONSTRUCTION or ALTERA1 110N PERM! I
SEPTIC TANK or CESSPOOI.
Permit No.
*,
Fee .$
DATE /0/-3/05
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. o. Box 972
MATTITUCK , NEW YORK 11952
SET;O CRSPOOL t'/
D,FSRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
C T1ON MAP: Must be attached hereto before permit way lie issued.
LOCATION Of PROPOSED CONSTRUCTION OR ALTERATION: -d/c 4.
OWNER OF PROPERTY: S A/1/fOi c m L z —5. -7'
OWNER MAILING ADDRESS:
________e,„. .._76,...4 4.45, ii_v_157:
OWNER PROPERTY ADDRESS: S4i/J if 721' g" vi
---3Ae)sAtrE_Elej, /Lot.
TELEPHONE NUMBER OF CONTACT PERsc 3/'- vin
53
4TAkc MAP NO. : Section /0 A Block -v� Lot .4.3 , c---
k,
GROW STREET: .S'7� v/_
.�L fid!a" =
BUILDING PERMIT NUMBER CROSS REFER' ICC
./4/A..,ee ss I_ .
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Siyta,tt11 e of AIIicant
RECEIVED BY:
own 1erk=s Office
DATE: ro/� d5
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SANDRA J. MEYER Z... :4k.....)
SANDRA SCOTT TUFFY
31025 MAIN ROAD
CUTCHOGUE
102-2-23.5
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