HomeMy WebLinkAboutMcDermott, Thomas SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3995 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: P 0 BOX 487
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMIT. ED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELTS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner THOMAS & ROSEMARY MCDERMOTT
Mailing Address 1 P 0 BOX 343
315 OLD SALT ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 315 OLD SALT ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 144.00 block 5 lot 20.000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/17/10 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE,RMC, CMC �$ '`' t l0 Town Hall, 53095 Main Road
TOWN CLERK ; ll 4 , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS lk
G 1% Southold, New York 11971
MARRIAGE OFFICER . Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER l Telephone (631) 765-1800
COMM
FREEDOM OF INFORMATION OFFICER = UN % '11 southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D c EllWE
TO: Southold Town Building Department DEC 1 4 2010
FROM: Carol Hydell, Southold Town Clerk's Office
BLDG.DEPT.
DATED: December 14, 2010 TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No. 3995 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Thomas & Rosemary McDermott
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. Thank you
Carol Hydell
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
r
Si ature r
Dated
rtiot, 44-1k
ELIZABETH A.NEVILLE �' `��` Gy Town Hall,53095 Main Road
TOWN CLERK O P.O. Box 1179
` Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �t
MARRIAGE OFFICER 'F Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ,"Ar V-0 Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER -___ * 1',l,, 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 Application No. 3 / / 5.
Permit No..
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. 0. BOX _.487
LAUREL, NEW YORK 11948
Septic Tz .2- or Cesspool
Brief Desci... ofl W d con4ruc ion or Altera n (�
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Location of Proposed Construction/Alteratio : Iyqo+t
Owner of Proe : a5 1\O /4 at.p � �
Owner Mailing Address:
Owner Property Address: 315_ 0 • ' j�p • alef4t
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Name and phone number of contact person 5-102 O 3O( ✓ Le/3W
Tax Map No: Section \ `1 , Block 5- Lot
Cross Street cud u
NOTE: LOCATION MAP ST BE SUBMITTED H APPLICATION. NEW
CONSTRUCTION REQUIRE SURVEY WITH HEALT ' D PART 14% • ' =OVAL
Signature of Appli . Date
Received by:
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