HomeMy WebLinkAboutElak, Alec SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3484 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ALEC ELAK
Address 1: P.O. BOX 296
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
-INSTALL & CONNECT NEW 8X8 POOL TO EXISTING POOL
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY
LINES, AND WATER BODIES
Name Of Owner ALEC ELAK
Mailing Address 1 P 0 BOX 296
City St Zip SOUTHOLD NY 11971
Property Address 1 1170 FOUNDERS PATH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 64.00 block 4 lot 500
Cross Street LANDON LANE
Building Permit Number Cross Reference:
Issue Date: 10/25/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
*4 F SOUTyo
ELIZABETH A. NEVILLE 1, �� l0 Town Hall, 53095 Main Road
TOWN CLERK * * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS o ,�
Southold, New York 11971
MARRIAGE OFFICER , �� Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER :�li�'COU,M �1' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 111 , ��
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold To-°vn Building Department
FROM: Michelle L. Martocchia, Southold Town Clerk's Office
DATED: October 16, 2006
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3639 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Alec Elak
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
/°/8/0
Dated
13/10 '06 FRI 14:34 FAX 631 765 6145 SOUTHOLD TOWN CLERK _.F]001.
c
ELIZABETH A.NEVILLE '� Town Hall,58095 Main Road
70\ P.O.TOWN CLERKBox 1179
REGISTRAR OF VITAL STATISTICS ivi
Southold,New York 11971
MARRIAGE OFFICER ' , Fax(631)765-6145
RECORDS MANAGEMENT OFFICER '��� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �' * P,,,' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERIVIIT
CESSPOOL or SEPTIC TANK
Residential @$10 x or Non-Residential @$25 Applicatio •. °�
Permit N, `S
Applicant Name L£C EJ. R
Applicant Mailing Address 0 13 a>( a Q6
Sou Ts h o
Septic Tank or Cesspool
Brief Description of Proposed nstraction or Alteration Z S7A
h„L�wc t?ea Td 46.1 ,r7.4. ,►4 jam` o0L
Location of Proposed Consttuction/Alteration:
Owner of Property: ? A 6c- ��A e
Owner Mailing Address: P. 0 -a a5 6
� Saw, ok0 rip r 1 )971
Owner Property Address: 1I 7� ,fie�r�. S inti'J'1
S 0 N• `' 119 7 i
Name and phone number of contact person 4i a G~�A�C. 7C,S'• eZ a f y/
Tax Map No: ) Section (Oct Block ! Lot S
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
Received
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