Loading...
HomeMy WebLinkAboutBrunet, Beverly (2) SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3468 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : BEVERLY BRUNET Address 1: 184 MARCELLUS ROAD City St Zip MINEOLA NY 11501 Descripton of Proposed Construction or Alteration -ADDING OVERFLOW POOL -MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, PROPERTY LINES, BUILDINGS, AND WATER BODIES. Name Of Owner BEVERLY BRUNET Mailing Address 1 184 MARCELLUS ROAD City St Zip MINEOLA NY 11501 Property Address 1 540 VANSTON ROAD City St Zip CUTCHOUE NY 11935 Tax Map No. section 104.00 block 12 lot 9.000 Cross Street Building Permit Number Cross Reference: Issue Date: 9/18/06 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ELIZABETH A. NEVILLE •' h Town Hail, 53095 Main Road TOWN CLERK 4 4 Pb..- Box 1179 REGISTRAR OF VITAL STATISTICSt.% Gt� Q i Southold, New York 11971 MARRIAGE OFFICER iC` -O �� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER . ��10 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER OFFICER .... , southoldtown.northfork.net 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. 3623 for a Cesspool/Septic Tank Construction or Alteration Permit submitted by: Beverly Brunet 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: ..00,11400 " 'j`_' — '1 : ' �'�� 44.-+ � 74/.6.'4°°441V --/ '.. S ignature j,110 06 Dated • '/���#1 .�..--- • s3F04 = ELIZABE'T'H A.NEVILLE ���`t` 4 \ Town Hall, 53095 Main Road TOWN CLERK t 1 . 11 P.O.Box 1179 i Southold, New York 11971 -' REGISTRAR OF VITAL STATISTICS " ♦M Al MARRIAGE OFFICER : G '� Fax Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 4;* 0.►►► Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER = RI * #„10. southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 or Non-Residential @ $25 Applicatio- o 0% Permit No 5.4�,. Applicant Name L)CVQ..,c\UJ CJ: valet Applicant Mailing Address 1 t 1-\ rnCTC(.\\ v.s Pcx:C.i Y\-kleo\G, N \ \ 1 v 8413 Septic Tank or Cesspool ✓ Brief Description of Proposed Construction or Alteration ci"d n�� ©'er-C\°' \ Location of Proposed Construction/Alteration: Owner of Property: )C veC\y cuC"Q,'r Owner Mailing Address: 1 `-1. 6'kQ P 1\k- cid fU 1fc )\Q mL,T) \ I Owner Property Address: 540 \I On-kx- . a)1cOncTik. ) \`CA33 (0- !.,,,.. ,\ PQcK Name and phone number of contact person '7.32-1 - 1e`''-W ►, - 0.0.' Tax Map No: Section '/73889 Block )O / Lot 12 9 Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY TH HE T DEPARTMENT APPROVAL Signature of Applicant Date Received by: 1it ^ .-tYt .. M ¢ M '` ''-' Lo-F t 92 r ,,_ L 0t 19.., '— t ;94,- . I i f \,,„,\ F.'".` .Tl 7>•.. V , � fes_ 1 \./-.4 10- 30T_3 to D r '.a test s. t 1 1-) ? 0 ,_....,....7v. •• _ _re s 4 � alt t. i bl - -Y 4, -34 1 : Tt 0 `` ✓. . .. .,..-„, , .. _ cri U) '---,-....4. )..n, p 1.......0.* J 0 ( j I / Ae l f 3 �=: MAP rF ` NO �r :',, J SL;RV=`'LL FGA / • ''-'4:`... M. J bEVEr-:;_ R.T ,..-). � )i-_'_'" '� ._ t st�cie - so l. ,' : AT o-- 4iQr'�. �I ...-'1- c� '- -i` J/Y1tmsORRlw ALTERATION OR ADDITION * tea `4' F'`S -. j '� e t TO THIS SURVEY IS A VIOLATION Of s `Srt SECTION 7209 OF THE NEW YORK STATE x Tow f`J F '._'0 - ":'&-'. , { EDUCATION LAW.... COPIES Of THIS SURVEY MAP NOT BEARING 1E�4 } 9•'. ME LAND SURVEYOR'S INKED SEAL OR BOSSED SEAL SHALL NOT BE CONSIDERED GLACE VCTI +' eJ '-� --I ''ITI'S" EM , ;I. , TO K• VAUD TRUE COPY. V L1.'1 Y:./1..''t .2 •.,...5!.'1,......P.-',..4 idly GUARANTEES INDICATED HEREON SHALL RUN '.7 ONLY TO THE PERSON FOR WHOM THE SURVEY Y'fap a 1t1 y ti, VA.IJ TL!Y L P-v. : ^ IS . AND ON HIS BEHALF TO THE IC s•1- L;(1..41MK JG Y .Z ftO VI F'. Y 4:.t '21%, '�**/-`N'F.!t+_'�:. mu COMPANY.GOVERNMENTAL AGENCY AND 2 .\/, y I! 1 Z j f f" y INMRIG INSTITUTION USTED HEREON,AND IQt oT 1'�.: '3:...N ,�1 r , rt( t e.:S •t — • TO 111E ASSIGNEES Of THE LENDING INSTI- Ol lcL.Oi .. 4111'4'.. le-,Ec'_ ,) I Z__ :1, MICH.GUARANTEES ARE NOT TRANSFERABLE L i CC ISC 01 1--<-1,-,:t St 4 Y_ :, , ,- ‹ A, 'w t`il , i 56- To Aoorowll TSTIEUIIONS OR SUBSEQUENT ZyyCt-_.I,0OY'k t�1:2 Yl N....4y}C - __—.._...,._________._ __---o""" -- .TLt♦