HomeMy WebLinkAboutCollins, Levy .�
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; ELIZABETH A. NEVILLE � O Town Hall, 53095 Main Road
TOWN CLERK l�I 1�[ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G Q Southold, New York 11971
MARftIAGE OFFICER � • �O Fa1c(631) 765-6145
RECORDS MANAGEMENT OFFICER l ��V Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �C�Un 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. 3432 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address l: P O BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
-ADDITIONAL POOL TO EXISTING SYSTEM
-MAINTAIN REQUIRED SETBACK FROM ADJACENT WELLS, BUILDINGS, WATER
BODIES, PROERTY LINES. EXCAVATION INSPECTION REQUIRED
Name Of Owner LEVY COLLINS
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Mailing Address 1 8995 MAIN ROAD
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P O BOX 771
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City St Zip MATTITUCK NY 11952
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Property Address 1 SAME AS ABOVE
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City St Zip 0000
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Tax Map No. section 122.00 block 6 lot 18.000
Cross Street FACTORY AVE
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Building Permit Number Cross Reference:
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Issue Date: 4/27/06 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
.
.� ��OF SO�ryo
, ELIZABETH A.NEVILLE '`� l� Town Hall, 53095 Main Road
TOWN CLERK � � P.O. Box 1179
va a� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G Q
MAR,RIAGE OFFICER '.�c� � �� F�(631) 765-6145
RECORDS MANAGEMENT OFFICER �l�'CO �� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER U�+ southoldtown.northfork.net
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OFFICE OF THE TOWN CLER�: } �; ; �?
TOWN OF SOUTHOLD � ,
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TO: Southold Town Building Department
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FROM: Linda J. Cooper, Southold Town Clerk's Office ��,--- ,
DATED: Apri125, 2006
Transmitted herewith is a copy of application No. 3587 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cessqool for Lerov Collins
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office npay 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
V
DISAPPROVE
Comments: Maintain required setbacks from ad1acent wells, buildin�s, property lines and water
Bodies EXCAVATION INSPECTION REQUIRED.
( `�_
Signature
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Dated
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SOUTHOLU WASTEWA'TER DISI'c)Sl�i. UIS I ftlC l
APPLICAI'IUtJ
for
CONSTRUCI'ION or AL`TLItA i Ic�tJ r�r i�n:�l i
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Permit No. �j��j( �
Fee 'S
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� APPLICANT NAME: �c�otvic ccssNool�
APPL)CANT ADDRESS: P. o. eox 9�2
MA'I'TITUCK, NEW YORK 11�.�52
5���_,,,,CE�SPOOL �
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� QFS��lPTION C?F PROPOSEO CONSTRUCTION OR ALTERATION
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L�Q,�l�'�'�Q�) MAPi Must b� attACt�ed hare�o t�eto�-e E�r�ri��it ivay t�� issuecl.
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Lt� T� � �� PRQPOSED CONSTRUCTION OR ALTl:RA71�N:
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' '' ;�Q1N�ERy QF PRQPERTY: �
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' �WNE�t MAILINC AD�RESS: �f' �95'
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OWNER PROPERTY ADDRESS: ,��,�,�
TELEPHONE NUMBER OF CONTACT PERSUN: �3% � �
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TAX MAP NO. : 5@ctlon l ZZ E3locic C�. �- I_c�t / �S
Gi�'SS STREET: �,�2.�/��.,4��___. _ _ _
, BU�LDINC PERMIT NUMBER CROSS RCF[�R� �r,i :
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Siyiiature of A licar�t ����'
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R�CElVED SY: ��
� own Terk si Office `�--
DATE: �
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L�HU� LULLLN�
8995 MAIN RQAD
MATTITUCK
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