HomeMy WebLinkAboutKoch, John 01°14 F S0(/r2,,
ELIZABETH A.NEVILLE t� l0 Town Hall, 53095 Main Road
• TOWN CLERK t 4 4gP.O. Box 1179
N �r Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G Q
MARRIAGE OFFICER 4•O �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '�COUI1►1+� � , southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3445 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
-ADD OVERFLOW TO EXISTING SYSTEM
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY
LINES, AND WATER BODIES
Name Of Owner JOHN & BARBARA KOCH
Mailing Address 1 1075 VICTORIA DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 SAME AS ABOVE
City St Zip 0000
Tax Map No. section 78.00 block 9 lot 55.000
Cross Street MAIN BAYVIEW
Building Permit Number Cross Reference:
Issue Date: 6/08/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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/.0�o�OG SO(/ryDl ,`
ELIZABETH A.NEVILLE 4 : Town Hall, 53095 Main Road
TOWN CLERK * 4 t P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G ��
MARRIAGE OFFICER . ,� Fax (631) 765-6145
l
RECORDS MANAGEMENT OFFICER \ ,��.`a_�.r Telephone (631) 765-1800
FREEDOM OF INFORMATI 'ye"UN'i'1+ r,o , southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
MAY 3 1 ' TOWN OF SOUTHOLD
TO: ._--.- �Sauthotd"Town B
l._ uilding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 30, 2006
Transmitted herewith is a copy of application No. 3601 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for John & Barbara Koch
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.
* * * * * * * * * * * *
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. .
7.1•Ze.r...--441/ ...1.,..*„.,
Signature
DVc. Vo 6
Dated
•
OSTICS Of THE TOWN CL&P.K ' +`` f I�j�
rowNorsoun+ow i '�'�! Application No.
ELIZABETH A.NBVILI$TOWN CLERK e� � `
P.O.BOX 1179 • Co tfoniy
SOUTHOLD.NEW YORK 11971
P • Iteratio
Tele hone
It
�0 � ysi�' $10.00 - •s dentias L...
P
(631) 765-1800 = 41 > �;,o'� $25.00 - Non-Residential
• --
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
3-AL !)APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE
• APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTLRATION:
OWNER OF PROPERTY: .k)-•/1.4.... ,
OWNER MAILING ADDRESS: 1 07S' Vic to/(1 D
500'0101d 10 . Y 1 14 7
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: Mr- 945k
TAX MAP NO. : Section i8 ,, Block q Lot 55
CROSS STREET: w /1)÷-1/1"./.-uv
BUILDING PERMIT NUMBER CROSS REFER} ICI"::
teh/w„..z,...06_4
Signature of A licant
} RECEIVCD
RECEIVED BY:
Town dark's Office"-"IAAY 3 0 2006
DATE:
Town Of Southold
P.O Box 1179
• Southold, NY 11971
* * * RECEIPT * * *
Date: 05/30/06 Receipt#: 9570
Transaction(s): Reference Subtotal
1 1 Septic Permit-Construct- Resid. 3601 $10.00
Check#: 9570 Total Paid: $10.00
Name: Peconic, Cesspool
P 0 Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID:3601
JOHN & BARBARA KOCH
1075 VICTORIA DRIVE
SOUTHOLD
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