HomeMy WebLinkAboutKar, Matthew •
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3987 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
WELTS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner MATTHEW KAR
Mailing Address 1 750 LITTLE PECONIC BAY RD
City St Zip CUTCHOGUE NY 11935
Property Address 1 1475 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 141.00 block 1 lot 8.000
Cross Street HORTON AVE
Building Permit Number Cross Reference:
Issue Date: 10/18/10 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE,RMC, CMC ,1,°�'`OV. Olc Town Hall, 53095 Main Road
TOWN CLERK 4[ 4[ P.O. Box 1179
va Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; G ,1
MARRIAGE OFFICER ` . �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER o�y� �.+�'ilTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER DUIY 1�, of southoldtown.northfork.net
• of
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
-.--:11ECEVVE
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: October 12,2010 Alt OCT - �. x.'10
Transmitted herewith is a copy of application No. 3987 for a Cesspool/Sep tit-Fang "' '•• iN
Permit submitted by: in r,or Q ' 'Eao!D �1
Peconic Cesspool for Matt kar
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. .
Signature 74(71 6/1-4'r''
/ °/ is
Dated
ELIZABETH A.NEVILLE �,; �Gy(\ Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Z ; Southold,New York 11971
Oy .F
MARRIAGE OFFICER
; $ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER
�If GIN" 0 Telephone(631) 765-1800
-
FREEDOM OF INFORMATION OFFICER _e't * +00 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10or Non-Residential @$25 Application No. ?g7
Permit No..
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. 0. BOX 487
LAUREL, NEW YORK 11948
Septic Tz ., or Cesspoo
Brief Description of PrioRosed tnstructionnr Alteration
c oi&t t lc 1?Cc CES .. / 0- --t--) 7
Location of Proposed Constru, 9n/Al ration:
Owner of Property: / !60� I-" �,` `,�
Owner Mailing Address:
Owner Property yAddress: /47 r' �`'(..,l
Pat:: 711
(1-°Z.
Name and phone number of contact person ,5 —8
Tax Map No: Section 1 Li 1 . Block 1 Lot F
Cross Street -1--\ crCtirbl A
NOTE: LOCATION MAP MUST BE SUBMITT' 1 WITH AP 3C N. NEW
CONSTRUCTION REQUIRES SURVEY WITH H r •1 TH DEPART T APPROVAL
i G'
Signature of Applicant Date
Received by: c---\\
1\r
li
1
il i 21-1 ) )' ,
/.
ti1G-QC.PS ot. Cc ',1
c
, _
.._ (,3)
0.._ _ ,_____, \
-,4 1
1 \ W, ,,e_ ,1
,_N.)�
O ce c
N