HomeMy WebLinkAboutTapfar, George 1
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SCUT-I-MD VIASTEVAATER DI SPC AL PERM T
CCNSTFcTI CN CR ALTERATI CN PERM T
SEPTI C TANK or CESSPOOL
Per nit Iib. 4174 R Resi dent i al X km-Resi dent i al
Fee $ 10. 00 Sept i c X Cesspool
PERM T I SSI.ED TO
Name : PECCN C CESSPOOL
Address 1: P O BCC 487
City St Zip LALFEL NY 11948
Descr i pt on of Proposed Const r uct i on or Al t er at i on
Al]] TI CN TO EXI STI NG SYSTEM
APPRCWED AS SU3M TIED! MPJ NTA] N FEW RED SETBACKS FROM ADJACENT
WELLS, BU LDI NGS, PROPERTY LI NES AND MATER BCD] ES.
Name a Owner (ECRCE TAPFAR
NTei I i ng Address 1 1805 BRAY AVEN E
O t y St Zip LAUREL NY 11948
Property Address 1 1805 BRAY AVFJ&E
City St Zip LALAEL NY 11948
Tax Map No. section 126. 00 bl ock 8 I of 13. 000
Cr oss Street ALSO DRI VE
Bui I di ng Per nit Number Q'oss Ref er ence:
Issue Date: 10/31/ 13 Elizabeth A Naville
Sout hold Towi a er k
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ELIZABETH A. NEVILLE,MMC 014°10 O4 Town Hall,53095 Main Road
TOWN CLERK , C • ; P.O.Box 1179
CA Z , Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ; `�' ��
O � � Fax(631)765-6145
MARRIAGE OFFICER =4* `► ��
RECORDS MANAGEMENT OFFICER 0,i .�`°�$�� Telephone(631)765 1800
FREEDOM OF INFORMATION OFFICER --... ...,..0•1°
�� www.southoldtownny.gov
OFFICE OF THE TOWN CLERK E
TOWN OF SOUTHOLD `
TO: Southold Town Building Department k,j 1 OCT 2 9 2013
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FROM: Carol Hydell, Southold Town Clerk's Office 1
DATED: October 29, 2013
Transmitted herewith is a copy of application No. 4174 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for George Tapfar
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 location map of the project cited above and make the following
recommendations:
Z.
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
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Signature
m/30/3
Dated
... . = ,g�,uFFolat"
. ELIZABETH A.NEVILLE A. 4 Town Hall, 53095 Main Road
TOWN CLERK ; § Z P.O. Box 1179
�� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS '' 00 of i
MARRIAGE OFFICER : 4 '� �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER , � 0...� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER `_'_O'� 4 tell southoldtown.northfork.net
..r
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. 14 t 7
Permit No.
PECONIC CESSPOOL
Applicant Name PO BOX 487
Applicant Mailing Address LAUREL NY 11948
Septic Tank or Cesspool If
Brief Description of ' off�, Construc 'on or Alteration
t r ICS Q1A Q,kw -, CP5T o j-
Location of Proposed Construc ' n/Alteration: ( r�
Owner of Property: 1 e✓ `CL
Owner Mailing Address:
Owner Property Address: 1 805- P_)rocui ��
Locmr�, < (Y w4g
Name and phone number of contact person C LeAlew ✓77? ---e13(
Tax Map No: Secion j' ,..C,,, Block S Lot 1 3
Cross Street A Q..& -0
11-';'L
NOTE: LOCATION MAP MUST BE SUBMITTED WI ' APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALT. i! PARTMEN ROV
I IP /0019 (3
Signature of App icant Date
Received by:
A-1/(0 0 111
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