HomeMy WebLinkAboutJKNK LLC .0, 4 SO(/ryo
ELIZABETH A.NEVILLE � '` l0 : Town Hall, 53095 Main Road
TOWN CLERK 4 lig
P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G Q
MARRIAGE OFFICER �O �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ` �COUPI+ ,, 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. 3429 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
-INSTALLING OVERFLOW CESSPOOL TO EXISITNG SYSTEM
Name Of Owner JKNK LLC.
Mailing Address 1 P 0 BOX 607
City St Zip ORIENT NY 11957
Property Address 1 13650 MAIN ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 11 lot 24.300
Cross Street WICKHAM AVE
Building Permit Number Cross Reference:
Issue Date: 4/27/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
- AR—
••• *0 S004,-
ELIZABETH A.NEVILLE e '`� l4 • Town Hall, 53095 Main Road
TOWN CLERK * Jill P.O. Box 1179
vs ac Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � G @ ��
MARRIAGE OFFICER �`'O �0,�/ Fax(631) 765-6145
RECORDS MANAGEMEN FICER _ ly 'rN 'i� Telephone(631) 765-1800
FREEDOM OFlNFQRMA OIjT,O'FICER C�Ury"+��►�� Southold,
•
aPR OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3584 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Peconic Cesspool
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:
Signature
Dated
i
WN CLEM �' ••
. OM*orralt TOTOIR4orIOVIHOLD 0 e 4 - , - Application
BLIZABTTh`X NBYIU&TOWN CLUkK :
PO.BOX 1179 I.
SOtTfHOT.D.NBWYORK11971 ` " t Constructio ... �irA!
i_ /
. Alteration
Telephone Q�',' $10.00 - Residential
(631) 765-1800 ---74t *$,,''' $25.00 - Non-Residential - :t---
' -• .__,ll
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.9
Fee .$
DATE 3 J %t / 06
_
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
"72) .14....g.&t.Le 41-0-4-4-/-4-g...., eir1.-.1.../1-7-7.-/ e%ei:0.-' ,- /.--e---2------4-%....0
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: J k ist 1.< 4, L 16
OWNER MAILING ADDRESS: P,- Prj G 07
O / l e Art
OWNER PROPERTY ADDRESS: I ( ,Q t I A.-.4 Aze
MATTI`i-vc- K
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TELEPHONE NUMBER OF CONTACT PERSON: iii -qL 54
TAX MAP NO. : Section I( t{, 5Iocic 11 - Lot a (h 003
CROSS STREET: LLrt -4. /LA--1. __
BUILDING PERMIT NUMBER CROSS REFERS ICI_-:: t.
___Sigilature of pplicant
RECEIVED BY ( �
Town Clerk's Office
DATE: U i` Inc—) .
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