HomeMy WebLinkAboutLeeds, William o .1
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3993 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 SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner WILLIAM LEEDS
Mailing Address 1 745 SMITH DRIVE NORTH
City St Zip SOUTHOLD NY 11971
Property Address 1 745 SMITH DRIVE NORTH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 76.00 block 1 lot 18.000
Cross Street MAIN BAYVIEW
Building Permit Number Cross Reference:
Issue Date: 11/30/10 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE,RMC,CMC 'tom 0 Town Hall, 53095 Main Road
TOWN CLERK ill 41 , P.O. Box 1179
N Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; G ,1
MARRIAGE OFFICER O 11 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER l1 Telephone (631) 765-1800
'M 111
FREEDOM OF INFORMATION OFFICER :TCDUIY 1 1,� / southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 22, 2010
Transmitted herewith is a copy of application No. 3993 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for William Leeds (SCTM 76-1-18)
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.
* * * * * * * * * * * *
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.
Signature
///, -/Z2
Dated
PI" ,,,,,,,,,,,,
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Ej,ABETH A.NEVILLE ail,� y iP Town Hall,53095 Main Road
TOWN CLERK : C$ P.O. Box 1179
°t, _ ` Southold,New York 11971
REGISTRAR OF VITAL STATISTICS : �1 i
MARRIAGE OFFICER `F e�� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER W NY 0 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER = (4 * +0 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
I/ .
Residential @$10 l' or Non-Residential @$25 Application No.2 3193
Permit No..
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. 0. BOX . 487
LAUREL, NEW YORK 11948
Septic Tzz-10- or Cesspool
Brief Desci tion of .posed Co tion or Alteration
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Location of Proposed Construction/Alteration: p
Owner of Property: 43,76 Lee o(c
Owner Mailing Address:
Owner Property Address: 7 /6----
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Name and phone number of contact person C -'6(- ( —1.3.3
Tax Map No: Section li Block ) Lot ft?
Cross Sheet
NOTE: LOCATION MAP MUST BE SUBMITTED ' - • 'P TI . NEW
CONSTRUCTION REQUIRES SURVEY WI '- :EAL DEPART APPROVAL
Signature of Applicant Date
60---- ��Iafl°
Received by: .
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