HomeMy WebLinkAboutKnudsen, William SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3997 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 WILLIAM KNUDSEN
Mailing Address 1 6425 SKUNK LANE
City St Zip CUTCHOGUE- . NY 11935
Property Address 1 6425 SKUNK LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 40 lot 5.000
Cross Street HAYWATERS DRIVE
Building Permit Number Cross Reference:
Issue Date: 3/08/11 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
r ��tog SO j74
ELIZABETH A.NEVILLE,RMC, CMC 1'f �O
e0 Town Hall, 53095 Main Road
TOWN CLERK , 4 illi , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % G ,) Southold, New York 11971
%MARRIAGE OFFICER t 4 . r Fax (631) 765-6145
N.
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =l yCOUN 1�4. ,� '•0I, southoldtown.northfork.net
S #i11
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD REC " V
TO: Southold Town Building Department FEB 2 3 ?O11
FROM: Carol Hydell, Southold Town Clerk's Office BLDG.DEPT.
TOWN o`SDUTNolO
DATED: February 24, 2011
Transmitted herewith is a copy of application No. 3997 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for William Knudsen
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: L .
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
21/6-e'4171V I.44/0/
Signature
/93/° - //
Dated
i
1iiiiii
'4-9
ELIZABETH A.NEVILLE /11/114 ` Town Hall, 53095 Main Road
TOWN CLERK p - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS _ Southold,New York 11971
MARRIAGE OFFICER ,417/ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =y?J 0.0 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER =_494iNg �`,, 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. 3 `l
Permit No.c.3 9,1
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. 0. BOX .487
LAUREL, NEW YORK 11948
Septic Tn.:- _or Cesspool
Brief Descx:ptio o •osed Co ction or Alt tion
._ ./ , 'r c 5 r%e\-- •
Location of Proposed Constructs n/Alteratioon:_
Owner of Property: KU D S EN V V(�--�--1
P
Owner Mailing Address: C ofJr-- 5 kAityvi k. Lowy
C‘kke/laooi
Owner Property Address: l0 S (4,VI vve_,
CWEC,&LoclCA&
Name and phone number of contact person 5 `o " 32
Tax Map No: Section 0`A Block 11 Lot Jr'
Cross Street Ha41 ln(C4e45
NOTE: LOCATION MAP IST BE SUBMITT % WITH AP' ICATION. NEW
CONSTRUCTION REQUIRES SUR WITH HE • TH DEPAR ` '. • AP ROV
De? Ok 3 //
Signature • •pplicant D to
Received by: _
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