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HomeMy WebLinkAboutRainey, James SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4019 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 JAMES RAINEY & SUSAN MURPHY Mailing Address 1 75 OSSEO AVE City St Zip SOUTHOLD NY 11971 Property Address 1 JAMES RAINE & SUSAN MURPHY 75 OSSEO AVE City St Zip SOUTHOLD NY 11971 Tax Map No. section 87.00 block 3 lot 17.000 Cross Street MINNEHAHA Building Permit Number Cross Reference: Issue Date: 6/08/11 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) . ���,/�*pf SO(i11 ELIZABETH A. NEVILLE,RMC,CMC x..7.,/, O : Town Hall, 53095 Main Road TOWN CLERK * 4111i P.O. Box 1179 REGISTRAR OF VITAL STATISTICS G ,� Southold, New York 11971 MARRIAGE OFFICER �O 11 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER l 11 Telephone (631) 765-1800 1 FREEDOM OF INFORMATION OFFICER =�CDUNTY,� southoldtown.northfork.net �.„a .0' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: June 2, 2011 Transmitted herewith is a copy of application No. 4019 for a Cesspool/Septic Tank Construction Permit submitted by: Peconic Cesspool for Rainey 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: u G���„:- 27,, ,.7t...., Signature © /3:,0 Dated . t���` V Town Hall,53095 Main Road QTS A. ; _ A: P.O.Box 1179 TOWN CLERK Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 0 �.�f�+ Fax(631)765-6145 MARRIAGE OFFICER a 1 �0 �0 Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER - o t sautholdtown.northfork.net FREEDOM OF INFORMATION OFFICER =-_ OFFICE OF THE TOWN CLERK • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT - APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK p or Non-Residential®$25 Application No. 40161,Residential @$1 Permit No.. Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. O. BOX 487 LAUREL, NEW YORK 11948 Septic Tz�- or Cesspool Brief Desc. ption of ProAoRed Constructio o�eration 6A etAl Ser ((ls .. Location of Proposed Co truction/Alteratipn: , , comas M u,�r h S usav\ Owner ofPropertyN1 Owner Mailing Address: Owner Property Address: 7.5- 0 Ss -.... cuoe, 0„,, ...Ai- 0 ....Emirs -7 Name and phone number of contact person SiLeATtiv 514, - J . Tax Map No: Section 8-7 Block 3 Lot I Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED •TH APPLI TION. NEW CONSTRUCTION REQUIRES SURVEY '`— ' HE•.!',H v EPAR $ Iit 'P: a AL Signa - •"Applicant Date Received b • y 0C1 ustiol 44/1 1,6 ( 0 ( cello ot a 3•TI V 73 ) )5` X55 tad) (,4 I cdeiJ 55€.0e-