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Home My WebLink AboutMercier, Thomas (3) • SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3473 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : THOMAS R. & BARBARA MERCIER Address 1: P 0 BOX 1423 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration -MAINTAIN REQUIRED SETBACKS FROM ADJACENT WATER BODIES, PROPERTY LINES WELLS, AND BUILDINGS Name Of Owner THOMAS MERCIER Mailing Address 1 P 0 BOX 1423 City St Zip MATTITUCK NY 11952 Property Address 1 10530 SOUND AVE City St Zip MATTITUCK NY 11952 Tax Map No. section 122.00 block 2 lot 1.500 Cross Street FACTORY AVE Building Permit Number Cross Reference: Issue Date: 10/25/06 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) . •�•,✓ SOF S0jj16 ELIZABETH A. NEVILLE 0 i•O'v !O Town Hall, 53095 Main Road TOWN CLERK 41 , P.O. Box 1179 REGISTRAR OF VITAL STATISTICS t 111P co 4c Southold, New York 11971 MARRIAGE OFFICER ; � Fax Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER -Kt ,,, Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER : CQUMy .° southoldtown.northfork.net 0 c`, k C OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Michelle L. Martocchia, Southold Town Clerk's Office DATED: September 15, 2006 RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 3629 for a Cesspool/Septic Tank Construction/Alteration Permit submitted by: Thomas R. & Barbara Mercier . 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: ' j(-06:-.1-- 71/ ".1//2 ai 2 Signature //S/6 S// Dated • 1,,,,o�SUFFo�,�00 ELIZABETH A.NEVILLE ~� d Town Hall,53095 Main Road TOWN CLERK : ; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS VO �� Southold, New York 11971 MARRIAGE OFFICER yi7lo a�' �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 4 * V,,�i, Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER ,,,,,,,'� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT 24 73 CESSPOOL or SEPTIC TANK 404 Residential @$104 or Non-Residential @$25 Application •. (2-- Permit No. Owner Name 111 Q Mei iAr440/0\ A4e'row Owner Mailing Address TA 0 ' 7\ l' ri9 c- Owner Property Address 10 S)d $?ith'( Aka tq Owner Telephone No. 4)3)- Rlit 7 Tax Map No: Section ` 04 a Block c,2 Lot / S Cross Street ter C—d(I ihf ARC"- Please check each that applies: New Construction Alteration to Existing System )( Residential 'k Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) 01V)1K t?e� Signa e of Applicant Date Received—IY. ...-4. . THOMAS MERCIER 10530 FACTORY AVENUE MATTITUCK 122-2-15 NA/ 1 , 5 I, N 1 i \. . to t I - i .1 ‘.V \ . , ..- ----) • i , ! , ! I _ 4.4-14r-rev r"irs e ‘ i --- 014 . iktipotft44-t..,A, -