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HomeMy WebLinkAboutBerman, Sandra 1. 1 SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3941 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 SANDRA BERMAN Mailing Address 1 City St Zip 0000 Property Address 1 750 KNOLLWOOD LANE City St Zip MATTITUCK NY 11952 Tax Map No. section 107.00 block 1 lot 15.000 Cross Street GRAND AVE. Building Permit Number Cross Reference: Issue Date: 4/13/10 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) .0/10 S0(/j�,o ELIZABETH A. NEVILLE,RMC,CMC 1$ i' s 0 Town Hall, 53095 Main Road TOWN CLERK ; 'I[ Illi , P.O. Box 1179 ci, Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ; G @ ,� MARRIAGE OFFICER t -O �� Fax(631) 765 6145 RECORDS MANAGEMENT OFFICER , ill Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �C�UIV 1 1,�III� , southoldtown.northfork.net • .•i OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD IECEOWE APR 6 2010 TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office BLDG.DEPT. TOWN OF SOUTHOLD DATED: April 6, 2010 Transmitted herewith is a copy of application No. 3941 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Sandra Berman 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. ..e.,,<. .:-. , 21‹......- 7- Signature 4e%Y/:;0V/-0 Dated • txliistf ELIZABETH A.NEVILLE e Town Hall, 53095 Main Road TOWN CLERK o •; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICERO •F �� Fax(631)765-6145 RECORDS MANAGEMENT OFFICER ; _" aO�� � 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 V or Non-Residential @$25 Application No. 37 Li / Permit No. Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. 0. BOX .487 LAUREL, NEW YORK 11948 Septic Tank or Cesspool Brief Description ofPrpq osed Construction or Alteration LI o vv�R,A- aes5, o • 4J Location of Proposed Construction/ teration: Owner of Property: 4'1 Yo e� o -ui Owner Mailing Address: Owner Property Address: 750 110 Le °co( Lct MS T T ( T-UCK N H 9-o Name and phone number of contact person L-eS "� - eci3oz. Tax Map No: Section 10 7 Block f Lot 13 Cross Street 7 4 f k frt.0(LSv©of L - ._- NOTE: LOCATION MAP MUST BE SUBMITTED H APPLI al ION. NEW CONSTRUCTION REQUIRES SURVEY H HE r H I PARTME . ' ' ' e AL Signatur- •pplicant Date Received by: IV 5 C KkiJ °Lc 7 3 v 371 1