HomeMy WebLinkAboutIsaksen, Stan •
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ELIZABETH A. NEVILLE '` �/ Town Hall, 53095 Main Road
TOWN CLERK 4 4 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER 3 . ,1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER l �•� Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER '_r. "U y+N ��� 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. 3440 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: P.O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
-ADDITIONAL CESSPOOL TO EXISTING SYSTEM
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY
LINES, AND WATER BODIES
Name Of Owner STAN ISAKSEN
Mailing Address 1 P.O.BOX 294
City St Zip NEW SUFFOLK NY 11956
Property Address 1 455 KOUROS ROAD
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 6 lot 11.200
Cross Street GRATHWOHL ROAD
Building Permit Number Cross Reference:
Issue Date: 6/08/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE• '` 1 Town Hall, 53095 Main Road
TOWN CLERK 1 4 iNg % P.O. Box 1179
4 CO Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G Q ��
MARRIAGE OFFICER 1 4 Fax�1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER N. l it Telephone(631) 765-1800
L �I
FREEDOM OF INFORMATION OFFICER C�Ury',+so. southoldtown.northfork.net
viii. ••
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OFFICE OF THE TOWN CLERK
MAY I 0 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. 3593 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:
1 .
APPROVE
DISAPPROVE
Comments:
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7P41--"at,// ..-
Signature
61 /°
Dated
oincs or us TQW14 Wag 1 -I --(
2� 'w;
Application
rie'-' t
,.
MUM'A. 3
TOWN CLLkK �
°' Construction
SOUTHOW.NBWiYORK 11971 << r" � Alteration
Telephone ' ✓ r,I `# io oo Residential
(631) 765-1800 '�. � 4 , $�tr.00 Hon -Residential , -
,,,,l,
tOWN or SOUTIIOI.1)
SOUTHOLD WASTEWATER DISPOSA1. I)IS I RIC I
APl LICAIION
for
CONSTRUCTION or ALTIiRA 1 1HUI 1'E:IIMI 1
SEPTIC TANK or CESSPOOL.
Permit No.
Fee '$
DA i I: /°k
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952
SErr I CCESSPOOL v
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LQCtA►TIQN. MAP: Must be attached hereto before per-mlt may lie issued.
LOQt,TIQN Q1 PROPOSED CONSTRUCTION OR ALTE.RAT ION:
. OW ,.ER,' OF PROPERTY: f9-/, . 544E-Tt/ _. . ._. .
OWNER MAILING ADDRESS: je /� 01-95'
A/4,J Sit#040i_ &fr", //454
OWNER PROPERTY ADDRESS:
45'S hee/I-Ps
;TELEPHONE NUMBER OF CONTACT PERSON : 9-9 -q6SV
I..ot�i 1f >
' fAX. MAP NO. : Section /17 Block
I,n
ICRQ5S STREET: ./14. Lw-D—1 std
BUILDING PERMIT NUMBER CROSS RErt_RE ICIAI
4;(41/1/14 "
Siyt raturo of App$i t
RECEIVED BY:
Town—Clerk's Office —
DATE:
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