HomeMy WebLinkAboutStiles, William •
SCUTHCLD WASTEVIATER DI SPOSAL PERM T
C CNSTF C;rI CN CR ALTERATI CN PERM T
SO TI C TANK or CESSPCCL
Per nit Nb. 3926 R Resi dent i al X Nbn-Resi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSIED TO
Nacre :
PEON C CESSPOOL
Address 1: P O BCC 487
City St Zip LALFEL NW 11948
Descr i pt on of Pr oposed Const r uct i on or Al t er at i on
AEU TI CN TO EXI STI NG SYSTEM
APPROJED AS SLEM TIED MPJ NTA] N RECD FED SETBACKS FROM ADJACENT
VELLS, BU LI] NGS, PR TY LI NES AND MATER BCD ES.
EXCAVATI CN I NSPECTI CN RECD RED
Nacre a Owner VVLLI AM & JOAN STI LES
Mai I i ng Address 1 2700 NEW SU=FC LK AVENLE
a t y St Zip CXJTCI-IOGLE NW 11935
Property Address 1 2700 NEW SU=FC LK AVEIsLE
O t y St Zip OJTCI-KX E NW 11935
Tax Map Nb. section 116. 00 bl ock 6 I of 14. 000
Cr oss Street
Bui I di ng Per ni t Number Q-oss Fef er ence:
I ssue Det e: 1/ 12/ 10 EI i zabet h A Nevi I I e
Sout hol d Town a er k
(TOIt'I SEAL)
,‘,'• ui SOU45oI_
ELIZABETH A.NEVILLE,RMC,CMC ,' $ °4-\\ Town Hall,53095 Main Road
TOWN CLERK * *' P.O. Box 1179
y yc Southold, New York 11971
REGISTRAR OF VITAL STATISTICS .;G @ '�� Fax(631) 765-6145
MARRIAGE OFFICER '�► .-,'7
RECORDS MANAGEMENT OFFICER l i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �C�U ,� �� , southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: January 12, 2010
Transmitted herewith is a copy of application No. 3926 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for William&Joan Stiles
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
Dated
,,,,,iii.,--
SUFFOLt
c
t ELIZABETH A.NEVIT.LE �ieOF 04 \ Town Hall, 53095 Main Road
TOWN CLERK ; p . P.O. Box 1179
REGISTRAR OF VITAL STATISTICS _ Southold New York 11971
MARRIAGE OFFICER :O A..F �
'� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `\W OF 0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = ''� * 1a,'► 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 or Non-Residential @$25 Application No. 361
Permit No.
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. 0. BOX 487
LAUREL, NEW YORK 11948
Septic Tank ' or Cesspool
Brief Descriptiep oaf Propossd Constrgctio Alteration �y
67.-LU V4(0LZ X//L' ✓ `� .
I
Location of Proposed Cons ctiT/Alteration:
Owner of Property: 16 CG ld/f 40a�/J
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S / 7-
Owner Mailing Address:
,----> 41 (y/(9
Owner Property Address: 2 70 d / Y� --5
Aff
rizi-Yo:9ate Y 115
Name and phone number of contact person .S� — ,57>2 ---(ef ,->,-)
Tax Map No: Section / / 6 Block 7 Lot
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATI N. EW
CONSTRUCTION REQUIRES SURVEY WITH HE• i I EPARTMENT OV
Signa pp 'cant Date
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