HomeMy WebLinkAboutCollins, Kathleen ,
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ELIZABETH A. NEVILLE '`� l0 Town Hall, 53095 Main Road
TOWN CLERK � � P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �' � Southold, New York 11971
MARRIAGE OFFICER �'�c` � �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �IiYCOU�'�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 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. 3401 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DONALD FIELER
Address l: P O BOX 1692
City St Zip MATITTUCK NY 11952
Descripton of Proposed Construction or Alteration
-NEW DWELLING
Name Of Owner KATHLEEN COLLINS
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Mailing Address 1 540 E. 20TH STREET - MG
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City St Zip NEW YORK NY 10009
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Property Address 1 PECONIC BAY BLVD
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City St Zip LAUREL NY 11948
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Tax Map No. section 126.00 block 10 lot 21.000
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Cross Street BRAY AVE
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Building Permit Number Cross Reference:
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Issue Date: 2/Ol/06 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
�o��pF SOUT�,oI
ELIZABETH A. NEVILLE 4 Town Hall, 53095 Main Road
TOWN CLERK � � P.O. Box 1179
REGISTRAR OF VITAL STATISTICS U' � Southold, New York 11971
MARRIAGE OFFICER � � �� F�(631) 765-6145
RECOR.DS MANAGEMENT OFFICER �IyCOU'M'�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ir i� southoldtown.northfork.net
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� �' � �t OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
�AN - 4 a°�
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TO� �- �� S���a�o�d�Y'��iilding Department
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FRO : Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3554 far a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
' Donald Feiler
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:
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ELIZEIBETH A.NEVII,LE �` �`Z` � Town Hall, 53095 Main Road
. TOWN CLER,K � � - '. P.O. Box 1179
_ REGISTRAR OF VITAL STATISTICS x Southold, New York 11971
MARRIA4E OFFICER Oy � ��` Fax (631) 765-6146
RECORDS MANAGEMENT OFFICER O Tele hone (631) 765-1800
FftEEDOM 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. �
Permit No. O�
Applicant Name �bNO`� �,�
Applicant Mailing Address �'�� l,(��1 '!i
► �/��,�i�i
Septic Tank � or Cesspool N�
Brief Description of Proposed Construction or Alteration DV�►I�Cs
Location of Proposed Construction/Alteration:
Owner of Property: �F`��N �I�l� t (`1 cJ
Owner Mailing Address: ��� � � � �� �1M1�.
N� N " � a�o 9
Owner Property Address: �FCoI� �C �.�'a'r ���
L�v �-EL�
Name and phone number of contact person ���D �—1 t.t1'l_ �-�8'�'�'S�
Tax Map No: Section f�r Block �' Lot
�oDcti – t Z G to Zt
Cross Street �,R a T����,.
NOTE: LOCATION MAP MUST BE SUBNIITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S Y WITH AEALTH EPARTME APPROVAL
� � � � 45
gnature o lic t Date
Received by: r
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TOINN: �O�TH62LD
SU��OL���G�l�ITY, NY ,�
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SURVEYED 09-�-�1005
AMENDED II-OQ- 005
SUFFOLK GOUNTY TAX # � °�� � -..
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TIE DISTf�NGE FROM SU��OLK GOUNTY TP�X MAP JOHN C. EHLERS LAND SURVEYOR
6 BAST MAIN STREET N.Y.S.LIC.NO.50202
GR�PHIG SGALE I"= 40' RIVERHEAD,N.Y. 114a1
369-8288 Fax 369-8287 REF.\�,Server\c�pms�05�05-311.pro �
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