HomeMy WebLinkAboutWamback, Norman lir - w
SCUfHCLD VIASTEIMTER DI SPC6AL PERM T
CCNSTRUCTI CN CR ALTERATI CN PERM T
SEPTI C TAN( or CESSPOOL
Per m t Nu. 4355 R Rlesi dent i al X Nun-Resi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSLED TO
Nana : PECON C CESSPOOL
Address 1: P O BCD( 487
Cl t y St Zip LALREL NY 11948
Descr i pt on of Proposed Const r uct i on or Al t er at i on
AM TI CN TO EXI STI NG SYSTEM
APPRC)JED AS SLUM TIED MPJ NIA N RECD FED SETBACKS FROM ADJACENT
VELLS, BU LDI NGS, PROPERTY LI NES AND MTER BCCI ES.
EXCAVATI CN I NSPEGTI CN RECD RED
Nave a 0Aner NCRIVAN MI I ACK
Mai Ii ng Address 1 P 0BCD( 688
Cl t y St Zip MATT! TUCK NY 11952
Property Addr ess 1 3850 CAMP M NECLA RD
O t y St Zi p MATTI TUCK NY 11952
Tax Map Nu. section 123. 00 bl ock 5 I of 18. 000
Cross Street REEVE AVEM E
Bui I di ng Per m t Nunber Cr oss Ref er ence:
Issue Date: 11/ 18/ 15 Elizabeth A NeviIle
Sout hold Tow a er k
(TOJ'MJ SEAL)
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ELIZABETH A. NEVILLE,MMC ��•yo `ry Town Hall,53095 Main Road
TOWN CLERK `� d P.O. Box 1179
r Southold,New York 11971
REGISTRAR OF VITAL STATISTICS %.....r, �� Fax(631)765-6145
MARRIAGE OFFICER � tt 40. tosTelephone(631)765-1800
�
RECORDS MANAGEMENT OFFICER -_ of * •
•,•i www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER '- ,,,.,,••
OFFICE OF THE TOWN CLERK 1 -:,
TOWN OF SOUTHOLD l i i r- -
!l if
NOV 1 7 2015
TO: Southold Town Building Department ! i k
FROM: Carol Hydell, Southold Town Clerk's Office r`
DATED: November 17, 2015
Transmitted herewith is a copy of application No. 4355 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Norman Wamback
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:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
. , iwe'..rd‘7
Signature
/ r7 /5—
Dated
8 t
. RUZABRITE A.NSE • fiowj:Kati,53096 Mein Road
TOWN CSS
%.1-4,- 4. P.O.Box 1179
Soathold,New York 11971
REGISTRAR OF VITAL STATISTICS Pax($81)7654145MABRSAC MIME `
RECORDS Telephone(631)765-1804
MANAGEMENT
� 4:.��
FREEDOM OF INFORMATION OFFICER sOiiChold�owzs.nortlsfark net
OFFICE OF.THE 3XIVWN CLERK
• `OWN OF 8013%1101M
St?€3'I'J WM! ATL'RDISTRICT
A ,AQN
CONSTRUCTION or ALTERATION PERMIT
BOOL or C TANK
Residential®$10 - or Non-Residential Qa $25 Application No. Li 3 S 5..
Pesmrit No.
Applicant Name PECKNICSPOOL
Applicant Mailing:Address P• a. BOX
LAWEL4 NSW YORK 11948
Septic Tom- .or Cessi,coI. .
Brief Desc; ption of Posed ,• �' ction or ,on
ezat -v ' / a e 5s
Location of Proposed Cowl:m ti AIt on: /,,
Owner of Property: fVO(I7fl . Warnba/c
Owner Mailing Address: •
: j 6® �YY! /W' eo&- ��lOwner ProperAd�ss �j
n uc ' //ff,f
Name and phone number of coact person L eA/e/r �7a ?3,-Z
Tax Map No: Sermon ' 2 3 Block 5 Lot l e
Cross Street R
NOTE: LOCATION.MAP MUST BEi7V.:.., S WITH APPLICATION- NEW
CONSTRUCIION REQUIRES-SURVEY Wirt( :; : DEPAR�i APPR Ai,
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