HomeMy WebLinkAboutWalsh, Brendon SCUTHCLD VWSTEVWTER D SPCSAL PERM T
CCNSTR.CTI CN CR ALTEPATI (N PERM T
SEPTI C TAN( or CESSPCCL
Per rri t Nb. 4163 R Rlesi dent i al X Nin-Iesi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T ISSUED TO
Mane : PECCN C CESSPCO-
Addr ess 1: P O BOC 487
O t y St Zip LAUF EL NY 11948
Descr i pt on of Pr oposed Const r uct i on or Al t er at i on
AEU TI CN TO EXI STI NG SYSTEM
APPROJED AS SU3M TTED MPJ NTAI N FEW FED SETBACKS FROM ADUACENT
VELLS, BU LCI NGS, PROPERTY LI NES AND VWTER BCD ES.
EXCAVATI CN I NSPECTI CN RECD FED.
Name Cf Omer BREt4XN W4LSH
Mbi I i ng Addr ess 1 3405 (BAN) AVE
Ci t y St Zi p NATTI TUCK NY 11952
Property Addr ess 1 3405 GRAND AVE
O t y St Zi p WTI TUCK NY 11952
Tax Is,bp Nb. section 107. 00 bl ock 1 I of 8. 001
Cross Street
Bui I di ng Per rn t Number Cr oss Ref er ence:
Issue Date: 10/ 11/ 13 Elizabeth A Neville
Sout hold Town a er k
-\ T -
ELIZABETH A. NEVILLE,MMC tie Town Hall, 53095 Main Road
TOWN CLERK � O= P.O.Box 1179
t CA = Southold,New York 11971
REGISTRAR OF VITAL
Fax(631)PPP �t
O Fax(631)765-6145
MARRIAGE OFFICER y ��
RECORDS MANAGEMENT OFFICER 0,,( .���o° Telephone(631)765-1800
••"„'� ,•.� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: October 1, 2013
Transmitted herewith is a copy of application No. 4163for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Brenda Walsh
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: te
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,_property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
OCT - 1 2013 1 /0V ,/,
Dated
0100 FPI-.
OF 00'010000
, ,
ELIZABETH A.NEVILLE ,i,h� *.1\ Town Hall, 53095 Main Road
TOWN CLERK ; P.O.Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS �y.
MARRIAGE OFFICER '� 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `_4 At.0. Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER '— Vo•I 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 / Co 3
Permit No.
PECONIC CESSPOOL
Applicant Name PO BOX 487
Applicant Mailing Address LAUREL NY 11948
Septic Tank or Cesspool
Brief Desi''I; of Propos onstruction or teratio
i 1, . Wit. Cess
Location of Proposed Construc n/Alteratio
Owner of Property: re ni2 5 h
Owner Mailing Address:
Owner Property Address: J O a�40 at)e..
PI l iiicc.?
Name and phone number of contact person ,a 3o'
Tax Map No: Section 107 a Block 1 Lot , 1
Cross Street K, a ( I 0 e c ,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEAL• % 4PARTMEN % 'PROVAL
i/
eq- Signatureli Tt Date
Received by:
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