HomeMy WebLinkAboutDaly, Matthew SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3466 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 OVERFLOW TO EXISTING SYSTEM
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT PROPERTY LINES, BUILDINGS,
WELLS, AND WATERS BODIES.
Name Of Owner MATHEW & LAURIE DALY
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Mailing Address 1 P.O. BOX 78
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City St Zip MATTITUCK NY 11952
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Property Address 1 11250 MAIN ROAD
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City St Zip MATTITUCK NY 11952
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Tax Map No. section 122.00 block 3 lot 8.000
Cross Street BAY AVE
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Building Permit Number Cross Reference:
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Issue Date: 9/18/06 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
OF SO!/j�,ol
ELIZABETH A.NEVILLE '` Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICERl�COU + Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Q�� 23
TO: Southold Town Building Department
FROM: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: August 22, 2006
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3621 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Peconic Cesspool
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
Dated
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{ W6TOWN CPASOX1179 Construction _
SOUTHOLD.NBW YORK 11911 Alteration
Telephone /� 4 u.oo Itesidentlal
(631) 765-1800 �[' � 'S.00 Non -Residential
TOWN OF SOUT11011)
SOUTHOLD WASTEWATER DISPOSAi. DI!K 1 100.1
APPLICATION
for
CONSTRUCTION or ALTL HA I Wrl 111::IM11 1
SEPTIC TANK or CESSI1001.
Permit o.
Fee $
APPLICANT NAME: PECONIC CESSPOOL,
APPLICANT ADDRESS: P. 0. BOX 972
WrTITUCK, NEW YORK 11952
SE IC C�SSPOOL ✓
DFS RIPTION OF PROPOSED CONSTRUCTION OR ALTERA"f ION
- --
t,,,T!9WMAP: Must be attached hereto before permit may lie issued.
K
LQ 19t p PROPOSED CONSTRUCTION oil AL"rL:ItATION:
OWNER, OF PROPERTY:
OWNER MAILING ADDRESS: _ 10"U 7I
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON : C9 ft— j4l.$8
MAP NO. : Section 1 9�p2 Block -3 L.ot
STREET:
BUILDING PERMIT NUMBER CROSS RL T'11 1(-I
Sig.,ibh.tre cif Apr icant
RECEIVED BY:
Town 'Cierk s Office �-
DATE:
MATTHEW & LAURIE DALY
11230 MAIN ROAD
MATTITUCK
122-3-8
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