HomeMy WebLinkAboutCorbley, John SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4003 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN R CORBLEY
Address 1: 680 MASON DRIVE
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTRn. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WET,T,9, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner JOHN R CORBLEY
Mailing Address 1 680 MASON DRIVE
City St Zip CUTCHOGUE NY 11935
Property Address 1 680 MASON DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 7 lot 3 .000
Cross Street HAYWATERS DRIVE
Building Permit Number Cross Reference:
Issue Date: 2/03/12 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE,RMC, CMC I O : Town Hall, 53095 Main Road
TOWN CLERK ll l [, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ih
G ,� Southold, New York 11971
MARRIAGE OFFICER �O �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ,i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =y0OUIY 1(,* ,• ,
_ l southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 1 li) E C 2211 `', ' r, , I A r-''' ' '
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TO: Southold Town Building Department _ i
FROM: Carol Hydell, Southold Town Clerk's Office Pi DG DEPT.
TOM OF SOD'THOLD
DATED: March 31, 2011
Transmitted herewith is a copy of application No. 4003 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
John R. Corblev
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:
APPROVEi.77'''''' leez.e.e..g....4: -...... "itisr.47*---.---e
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
(24,/ac....„..‹), ;-?dr,
Signature
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Dated
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ELIZABETH A.NEVILLE .i'ht V\ Town Hall, 53095 Main Ron
TOWN CLERK .:. ,. P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �►� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER \$4, t%V. Telephone(691) 765-1800
FREEDOM OF INFORMATION OFFICER = O_" 40 ",,I southoldtown.northfork.ne?
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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. LK)°-----3
_ /^� Permit No.
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Applicant Name "--
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Applicant Mailing Address 6)3 O `, CY\J
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Septic Tank )<or Cesspool
Brief Description of Proposed Construction or Alteration Cit 01- t i AJ�
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Location of Proposed Construction/Alteration:
Owner of Property: -"j-C)-5/0 f`. C ) L4
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Owner Mailing Address:
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Owner Property Address: 6 80 in9"j0PJ 01Z
C&ci -- oliAl Mass
Name and phone number of contact person O? J 5 � -7 3g_Z y
Tax Map No: 3 ection )O'1 Block COCn Lot 003
Cross Street S Pi-tide--
NOTE:
&(-' ._NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S " k • " . • ALTH DEPARTMENT APPROVAL
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gna �� s1icant Date
Received by:
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