HomeMy WebLinkAboutKropp, Alan SCLITHCLD V1 STEW*TER DI SPC6AL PERM T
CCNSTRLICTI CN CR ALTERATI CN PERM T
S I C TANK or CESSPOOL
Per rri t Nb. 4180 R Resi dent i al X Nbn-Resi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSU=D TO
Narre : PECCN C CESSPOOL
Address 1: P O BOAC 4180
City St Zip LALFEL Nr' 11948
Descr i pt on of Pr oposed Const r uct i on or AI t er at i on
Al]] TI CN TO EXI STI N3 SYSTEM
APPROJED AS SU3M I I EU Mal NTAI N FEW RED SETBACKS FROM ADJACENT
VELLS, BU LDI NGS, PROPERTY LI NES AND \##TER BCD ES.
Nam Cf Owner ALAN K JPP
Mai I i ng Address 1 975 NERTH OAKIND D ROAD
City St Zip LAUREL NY 11948
Property Address 1 975 NORTH CAMCD ROAD
Qty St Zip LAUREL NY 11948
Tax Map Nb. section 127. 00 bl ock 7 I of 11. 000
Cr oss St r eet PECCN C BAY BLVD
Bui I di ng Perri t Nunber 0 oss Ref er ence:
I ssue Cat e: 12/ 10/ 13 El i zabet h A Nevi I I e
Sout hold Tovtn a er k
0, c, F FO(,�-'
ELIZABETH A.NEVILLE,MMC i$100 C�(t Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
y Z ; Southold,New York 11971
REGISTRAR OF VITAL STATISTICS :`�' ��
‘ito• Fax(631)765-6145
MARRIAGE OFFICER y� .1' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ': �.( `�►a�0.�i� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department DEC - 2013 •
FROM: Carol Hydell, Southold Town Clerk's Office \ _ __I I
DATED: December 5, 2013
Transmitted herewith is a copy of application No. 4180 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Alan Kropp
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me. Thank you
* * * * * * * * * * * *
I have reviewed the application and cation map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
/V°9/3
Sign
Dated I
II,,i'A,3FFO(4.
e);-%
ELIZABETH A.NEVILLE ''', 4 Town Hall, 53095 Main Road
TOWN CLERK . ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Z Southold New York 11971
` Fax(631) 765-6145
MARRIAGE OFFICER O '� 1�$
RECORDS MANAGEMENT OFFICER if ,O 01 Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER `' V * 1P010 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. 1 D
@ @ PP
Permit No.
PECONIC CESSPOOL
Applicant Name PO BOX 487
Applicant Mailing Address LAUREL NY 11948
Septic Tank or Cesspool V
Brief Descriptio • `• osed C;i traction or Al ration
� P
Location of Proposed Constructio `1t ation:
Owner of Property: Ctn 1,
Owner Mailing Address: Y75- 111 '� � �e(
j
/107,119,.
Owner Property Address: y75.- lio h OqbvocOd'
67(
I cL /U
// 14f
Name and phone number of contact person (-2'&(- 57°Z V ( 3�
Tax Map No: Section a. . Bloc Lot / /
Cross Street P • •
NOTE: LOCATION MAP MUST BE S P I TTED WIT • APPLICA ON. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALT . I PARTMENT 4.R0 •.
/ 1
( t L'N Signature ofCA hcant Date
� PP
Received by:
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