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Cutchogue Presbyterian Church
SCJTHCLD VI STEVAATER d SPOSAL PERM T CONSTRUCT! CN CR ALTERATI CN PERM T SEPTI C TAN< or CESSPOOL Per m t Pb. 4232 R Fesi dent i al X Nbn-Fbsi dent i al Fee $ 10. 00 Septic X Cesspool PERM T I SSIED TO Nana : PEOCN C CESSPOOL Address 1: P O BOD( 487 Cl t y St Zip LALFEL NY 11948 Cescr i pt on of Pr oposed Const r uct i on or Al t er at i on ACCT TI CN TO EXI STI NG SYSTEM APPRDIED AS SWM TTED NAI NTAI N WWI FED SETBACKS FROM ADJACENT V'ELLS, BU LCI NGS, PROPERTY LI NES AND VINTER BC] ES. EXCAVATI CN I IVSPECTI CN FEW RED Nana Cf Owner CUTC-IOGLE PRESBYTERI AN O-LR]-I Mai I i ng Address 1 P 0 BCD( 964 C t y St Zi p C TC JIE NY 11935 Property Address 1 27150 Mal N FOOD C t y St Zi p CUrC-OIG NY 11935 Tax Map No. sect i on 109. 00 bI ock 5 I of 4. 000 Cross Street Mal N ROAD Bui I di ng Per m t Nanber Cr oss Fief er ence: Issue Dat e: 4/28/ 14 Elizabeth A Nevi I I e Sout hold Tow, C er k ELIZABETH A.NEVILLE,MMC ' 44.,. 0 4 Town Hall,53095 Main Road TOWN CLERK % p - ik P.O.Box 1179 yZ $ Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p 01 Fax(631)765-6145 MARRIAGE OFFICER `. 4 �� RECORDS MANAGEMENT OFFICER :?�QI 1111 �a.1 Telephone oldt nny.gov FREEDOM OF INFORMATION OFFICER - ,,,*I° w�w.southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office , APR 2 ri4 z I DATED: April 21, 2014 I RE: Cesspool Construction/Alteration Application Transmitted herewith is a copy of application No. 4232 for a Cesspool/Septic Tank Construction Permit submitted by: Peconic Cesspool for Cutchogue Presbyterian Please review the application and location map and advise 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: APPROVE DISAPPROVE -2 Comments: .." 4-91-44‘..c.--‘" ." 4 / &,-4-e.€4, � �-�• l .-= Kms- 447:1°1-."' G� � � Signature O � Zr , Dated ,f E1r IZAB TH A.NEV LE cr Town Hall,53095 Main Road TOWN CLEF- S P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER ,0 S.; ' Fax(631)765-6145 RECORDS MANAGEMENT OFFICER '_ Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER _ * , �•. 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 Vor Non-Residential©$25 Application No. -3 Permit No. Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. O. BOX 487 LA , NEW Y_YORK 1194.8 Septic tic Ten- _or Cesspool V Brief De4X" iption pf• •,,osed •, •/:t*pr Alteration vici,e � / W 7 .. Location of Proposed Construction/ 'on: Owner of Property: C4 .4?"e3 ‘ag64 fi e(20? aid Owner Mailing Address: O .C494-- 7� _ ye„/11/1.3:5--- Owner / .3.5---Owner Property Address: a 7/540 fliie - • rre. Jf c-, /\/,V /19 -- Name and phone number of contact person 570?- ( 9302 Tax Map No: Section 109 Block S Lot L Cross Street NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY ' : :: AL 0': I EPARTME 1 APPROVAL It / .. Signature of Applicant Date Received by: I 'VI al CRC( \f/(:)tell a (Al S S 027150 \e cosro1 0u cospot 1