HomeMy WebLinkAboutPecha, Eleanor S
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4195 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 ELEANOR PECHA
Mailing Address 1 468 PENNSYLVANIA AVENUE
City St Zip WILLISTON PARK NY 11596
Property Address 1 250 BARTLEY ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 3 lot 30.000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 2/04/13 Elizabeth A. Neville
Southold Town Clerk
fi,,o��gUFFO(,�-co `
ELIZABETH A.NEVILLE,MMC serTown Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS '
O •Prt
�' Fax(631)765-6145
MARRIAGE OFFICER '4 , Telephone(631)765-1800
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RECORDS MANAGEMENT OFFICER * �a�%6 1.6 www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
lECEIIWE
TO: Southold Town Building Department JAN 2 4 2013
FROM: Carol Hydell, Southold Town Clerk's Office
BLDG.DEPT.
DATED: January 24, 2013 TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No. 4195 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Eleanor Peche
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:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
Dated
4iHili!'1 Ent G�N� `<, '` y'' .3t - - own.HA,W 095 Main Road
TOWN CLERK P.O.
But 1179
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st
C AR OFVITAL 8�F Soa#1tc�Id,3�e�vYork 11971
8E
1 J Fax(631)765.6145
MARaA08 .. �- - -� a'
RECORDSMAN _ '' T (631)765-1800
FREEDOM
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f. ,1301 TOWN r
coranwencet or ALM:RATION MOST
-CESSPOOL or ssPricrAteK
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Resideaitial(a3$10__ or Non- a {r#$25 Application. No. Ll
Ptio.
Applicant Name eimeame CESSPOOL
Applicant MaffmgAddneas P• 0
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septic
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Location ofPrcrposed Oona , .;,
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Owner ofPraperty:
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(� � � � a�, �� eOwner Mating Adams:
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°wner Pr°PerrYjWdresm ill lii/CC , /V 0 6--0.
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Name and ply rumbad person
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Tax MapNo: I t-I L-Lr.)310dE 3 Lot 3o
Cross Sheet �'--fi
NOTE: LOC is % V; AP I-..z. ON. NEW
CONSTRu gY ii; :1:. >, l 3 ! APDROVAL
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sanatareut . ta,, Date
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