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HomeMy WebLinkAboutLignos, Elias SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4320 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : PECONIC CESSPOOL Address 1: PO BOX 487 City St Zip LAUREL NY 11948 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM APPROVED AS SUBMI'r1'j;U. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. Name Of Owner LIGNOS ELIAS Mailing Address 1 100 SUMMIT DR City St Zip MATTITUCK NY 11952 Property Address 1 100 SUMMIT DR City St Zip MATTITUCK NY 11952 Tax Map No. section 106.00 block 2 lot 10.000 Cross Street CENTRAL DRIVE Building Permit Number Cross Reference: Issue Date: 6/09/15 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) // ,,iii..,,_ ._ NoguFFot,�eD'; ` ELIZABETH A.NEVILLE,MMC �,�y0 Yy Town Hall,53095 Main Road TOWN CLERK P.O.p� Box 1 179 N Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS PP, ��� Fax(631)765-6145 MARRIAGE OFFICER y ! �� RECORDS MANAGEMENT OFFICER '� 1 * �►a�i'� Telephone(631) vnny.g v ��•' www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER .•-,,,,..•' OFFICE OF THE TOWN CLERK r , TOWN OF SOUTHOLD j j JUN - 1 2015 TO: Southold Town Building Department j FROM: Sabrina Born, Southold Town Clerk's Office _.----- DATED: June 1, 2015 Transmitted herewith is a copy of application No. 4320 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Lignos 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. . EIVED REC Signature f JUN 8 2015 a0S /5"-- Dated Southold Town Clerk ELIZABETH A.NEVILLE,MMC 3 Town Hall,53095 Main Road TOWN CLERK w ' ` P.O. Box 1179 c '�;;-: � Southold,New York 11971 REGISTRAR OF VITAL STATISTICS <'� "`" ° Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD June 9, 2015 Peconic Cesspool PO Box 487 Laurel, NY 11948 RE: 106.-2-10 (Lignos Elias) Dear Sir/Madam: • Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars ($10.00) for a residential system and twenty-five dollars ($25.00) for a non- • residential system. Your check should be made payable to the "Southold Town Clerk". An application form is enclosed. Please complete the requested information and return the application, proper fee, and LOCATION MAP (map must indicate the location of the cesspool(s)/septic tank(s), giving approximate distances in feet from any buildings to the pools and distances between the pools. Should you have any questions concerning this matter, please do not hesitate to contact this office. Very truly yours, *W11 Sabrina Born Clerk Typist Enclosures `O��- --g BGG�: Town Hall,53095 Main Road rirgeRTT$A.�E ;''a y : P.O.Box 1179 TOWN CLERK z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ?Q ,F�I Fax(631)765-6145 MARRIAGE O�(Eg = r- !� Telephone f 631)765-1800 RECORDSOFINFORMATION MANAGEMENT OFFICER '- j * " southoldtown.northfork net FREEDOM OF 7NFORMAZ'FON OFFICER ------ - OFFICE OF THE TOWN CLERK • TOWN OP SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Application No.r 0 Residential @$10 or Non-Residential©$25 ��No. Applicant Name PECONIC CESSPOOL Applicant Mailing Address P• 0. BOX ..487 LAUREL, NEW YORK 11948 Septic Ta: :- or Cesspool + ;on or Alterationo,o i i'iI ,r. iptio04 t ©Propos , .‘;',.'i oec5 Location of Proposed Construction/Alteration: r Owner of Propel Li n OS Ot.c/ cj Address: -_ ,.. .0 iii/4'44 al �- Owner Mailing Address: 'w- e 4 / S Owner PropertyAddress: lQ 0 rop9sepi AV 1 L?�c Name and phone number of contact person Tax Map No: Section /0 (I, Block 2 Lot /0 Street C ''llijg _ 7' Cross s NOTE: LOCATION. MAP MUST BE SUBMITTED tout APPLI • . - N. NEW W CONSTRUCTION REQUIRES ' :i'd - ARTME ;Roy iit .►.P0 '7('7(5 Si re of Applicant Date .(51,(Ley Received by: r � E Pr 5 X00 i i 7 , i dp 1 4r Cesv,2oo{ ,, 0 ( 5 1,t Nq h(l .J t