HomeMy WebLinkAboutTrabaliki, Diane SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3492 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
-REPLACE COLLAPSED CESSPOOL WITH NEW ONE
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT PROPERTY LINES, BUILDINGS,
WELLS, AND WATER BODIES.
Name Of Owner DIANE TRABALIKI
Mailing Address 1 P 0 BOX 7185
City St Zip BRECKENRIDGE CO 80424
Property Address 1 4080 OAKLAWN AVE EXT.
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 43 lot 900
Cross Street PINE NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 12/11/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE '` Town Hall, 53095 Main Road
TOWN CLERK ; 4 illZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G q� ��
Southold, New York 11971
MARRIAGE OFFICER �O r Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER % l ��1• Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER C�U,ry 1 1��// •
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department
FROM: Michelle L. Martocchia, Southold Town Clerk's Office \__-
DATED: November 20, 2006
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 3648 for a Cesspool/Septic Tank
Construction/Alteration Permit submitted by:
Peconic Cessp000l .
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
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Comments: i
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Signature
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Dated
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ELIZABETH A.NEVILLE MP �4•`; Town Hall, 53095 Main Road
TOWN CLERK a P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � j,. Southold, New York 11971
MARRIAGE OFFICER O .� $ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \— # D�ire Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =K "
Z �,,�,, 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. Coif g
Permit No , _
Applicant Name .,ttirmrr,
Applicant Mailing Address to. 972
by 1«SA
Septic Tank or Cesspool
Brie Description Proposed Construction or Alteration X25/
Location of Proposed Construction/Alteration:
Owner of Property: 00.-4 sl,G 7/L
Owner Mailing Address: /!D /3,2e 77/81'
0 , - - tea 8'd S99
Owner Property Address: 56,8D 0 ' a.L►.c.
A.P.
Name and phone number of contact person G 3/ --A- S,-96. Sr
Tax Map No: Section 7o Block �3 Lot ?
Cross Street 12-4-4-4. 7t,�4... .-1--gre'
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
441Z4Cf.--,41e :4,Ceee "46
Signature of Applicant t / Date
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Received by:
I
DIANE_TRABULSKI
4080 OAKLAWN AVENUE EXT
SOUTHOLD
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