HomeMy WebLinkAboutGarvey, Patricia SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3951 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 PATRICIA & ROBERT GARVEY
Mailing Address 1 P 0 BOX 25
City St Zip EAST MARION NY 11939
Property Address 1 3770 PRIVATE ROAD #1
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 3 lot 4.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 5/18/10 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
£
�0
AN% SO 1.40
ELIZABETH A. NEVILLE,RMC,CMC '$ '`� se) , Town Hall, 53095 Main Road
TOWN CLERK * 4 , P.O. Box 1179
i co
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS o Q ,1
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Ll �� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER :�C�UIl 1 i,� �I southoldtown.northfork.net
'1s°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD (Z C 2 nn E
L5 S V
TO: Southold Town Building Department _ MAY 1 4 2010
FROM: Carol Hydell, Southold Town Clerk's Office
BLDG.DEPT.
TOWN OF SOUTHOLD
DATED: May 14, 2010
Transmitted herewith is a copy of application No. 3951 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool - Garvey
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.
* * * * * * * * * * * *
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
40•S/7//e
Dated
ELIZABETH A.NEV LLE � ��� Gy�� Town Hall,53095 Main Road
TOWN CLERK : o - ; P.O. Box 1179
cos
REGISTRAR OF VITAL STATISTICS t.. Mt
Southold, New York 11971
MARRIAGE OFFICER : G Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \** 40.0 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER =_�'r- '�iii �'a.'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
CIS
Residential @$10 or Non-Residential @$25 Application No. J
Permit No.
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. O- BOX , 487
LAUREL, NEW YORK 11948
Septic Tank ' or Cesspool
Brief D-., ioP of Pr posed Construc 'on or lteration
1�
Di► . t� c%t-S5,1��
Location of Proposed Construction/Alt�
P eff-Tation: _Owner of Property: K 1 C I A i �'E E`\ T G 4 KV C !
Owner Mailing Address: rc (00K 5-
Owner Property Address: 3770 fritia& koota qt.--.I
euf 1i%YOi N Y I I 9 3 9
Name and phone number of contact person ' {-ex- 6-102 - 0 q 3`'
Tax Map No: Section a Block 3 Lot y
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITT • WITH AP KATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HF• TH DEPAR OVAL
11111°1
SipaAi
p► t Date
Received by:
V. 4_
_1 (
c \ • 1-e
3770
(o
Town of Southold
P.0 Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 05/14/10 Receipt#: 79846
Transaction(s): Reference Subtotal
1 1 Septic Permit-Construct- Resid. 3951 $10.00
Cash Total Paid: $10.00
Name: Peconic, Cesspool
P 0 Box 487
Laurel, NY 11948
Clerk ID: LYNDAR Internal ID: 3951