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Home My WebLink AboutScott, Robert } • SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3955 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1: PP 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 ROBERT SCOTT Mailing Address 1 830 PINE AVENUE City St Zip SOUTHOLD NY 11971 Property Address 1 830 PINE AVENUE City St Zip SOUTHOLD NY 11971 Tax Map No. section 77.00 block 3 lot 15.001 Cross Street BIRCH Building Permit Number Cross Reference: Issue Date: 5/25/10 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) • r y • s''*pf SO0h,- • • ELIZABETH A.NEVILLE,RMC,CMC �O l0 : Town Hall, 53095 Main Road TOWN CLERKli l P.O. Box 1179 va Southold, New York 11971 REGISTRAR OF VITAL STATISTICS G Q ,� MARRIAGE OFFICER .O �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERl tp� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ` = COUIrIO southoldtown.northfork.net ----- OFFICE --,OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD D C E I TO: Southold Town Building Department MAY 2 4 2010 FROM: Carol Hydell, Southold Town Clerk's Office BLDG.DEPT. TOWN OF SOUTHOLD DATED: May 24, 2010 Transmitted herewith is a copy of application No. 3955 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Robert Scott 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. 211 Signature os----/e/0 Dated 1 v ELI ARETR A.NEVIL ;_ VI Town Hall, 53095 Main Road TOWN CLERKP.O. Box 1179 c ` cA = ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Q / Fax(631) 765-6145 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER . fit).0 Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER '� �',•`� 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 y or Non-Residential $25 Application No.3 /5 @ @ PP Permit No. Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. 0. BOX 487 LAUREL, NEW YORK 11948 Septic Tank or Cesspool Brief Des ri laon of Prop osTil Construco�c Alteration Location of Proposed Construc 'on/Alteration: _ -7— Owner ofProPProperty: 06E-RT 5C C 1 l Owner Mailing Address: k15 0 t1 i 1 e, (-4.,(1 e- ,,, c,, iti y I / 17I Owner Property Address: Name and phone number of contact person Lt . /\( 5-"a risk Tax Map No: Section 1 Block 3 Lot___L5-. I Cross Street e NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WIT HEALTH DP '�.�TMENT APPRO AL I i 46(6)t&?- --- T-7a /0 Signature of Applicant Date _±.4 Received by: c vv e- c.);ucc--f7,7r,o:' 3r(') fr ,