HomeMy WebLinkAboutKeogh, John SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3480 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: P 0 BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
-NEW CESSPOOL ADDITION TO EXISTING SYSTEM
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT PROPERTY LINES, BUILDINGS,
WELLS, AND WATER BODIES
Name Of Owner JOHN KEOGH
Mailing Address 1 P 0 BOX 646
City St Zip MATTITUCK NY 11952
Property Address 1 875 PIKE STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 2 lot 2.400
Cross Street WICKHAM AVE
Building Permit Number Cross Reference:
Issue Date: 10/25/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,,,,
• •, �pF SOURo-
ELIZABETH A. NEVILLE � Ol0 Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS y Southold, New York 11971
MARRIAGE OFFICER ,Ct• A Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER a, ,tea �I Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER CDUNTY,``� 0°.•
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK -71 CJo
TOWN OF SOUTHOLD
TO: Southold Town Building Department I 0
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3635 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:
APPROVE
DISAPPROVE
Comments: 2 11"e'19 _
Signature
A / 6 aG
Dated
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. Construction
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$QtJmow.NEW YORK 11971 .• --
T A s Alteration_
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Telephone _ i .. _ �
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(631) 765-1800 / ' , 1°' $25.00 Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL. DIS f RIC I
APPLICATION
for
CONSTRUCTION or ALTERA l It►N pi 'mil I
SEPTIC TANK or CESSI'OUI.
Permit NoC. hi
Fee .$
DATE 2o/ 7 Lam'
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952
SFrrn, .. C.ESSPOOL V
DESFI IPTION OF 'PROPOSED CONSTRUCTION OR ALTERATION
TI9N MAP; Must be attached hereto before permit. may be issued.
LO. . TIN 9F PROPOSED CONSTRUCTION OR ALTERATION:
• {`d gWNgiV OF PROPERTY: li tip
OWNER MAILING ADDRESS: PQ, I (o R __
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OWNER PROPERTY ADDRESS: g 75 p,C. 51-
TELEPHONE NUMBER OF CONTACT PERSON : 031 k. -q6. S$'
MAP NO. : Section 1 - Block 2 I_c,t L.if
CROSS STREET: ejlw..k
BUILDING PERMIT NUMBER CROSS REFERS ICI :
leeelr/t/ie
• Signature of pplicant
RECEIVED BY:
Town Clerk's Office —
DATE:
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vRANrES KEOGH
875 PIKE STREET
KATT TTIJeK
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