HomeMy WebLinkAboutGregory, Richard SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4349 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'Rll. MAINTAIN REQUIRED
SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER
BODIES.
Name Of Owner RICHARD GREGORY
Mailing Address 1 10 HARVARD ST
City St Zip GARDEN CITY NY 11530
Property Address 1 250 6TH ST
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 1 lot 10.000
Cross Street BRAY AVE
Building Permit Number Cross Reference:
Issue Date: 10/22/15 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
se
ELIZABETH A.NEVILLE,MMC '��y��' Ory L, Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
%t cIs s Southold,New York 11971
row
REGISTRAR OF VITAL STATISTICS ` `�' �
. p � �� Fax(631)765-6145
MARRIAGE OFFICER 's. -5' Qi' 0 Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER = � iii `�►j sof' www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER ----"-.•-..,..0.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
OCT '� 6 2015
FROM: Sabrina Born, Southold Town Clerk's Office
DATED: October 16, 2015
Transmitted herewith is a copy of application No. 4349 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Richard Gregory
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:
APPROVEi .
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
-/4Signature ti/
/ 21 r.—
Dated
ELIZABETH A.NEVILLE,MMC 4144-9 y Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
H z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS . ' Zr n Fax(631)765-6145
MARRIAGE OFFICER yti+' Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER
www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER Y a
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
October 22, 2015
Peconic Cesspool
PO Box 487
Laurel,NY 11948
RE: 126.-1-10 (Richard Gregory)
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,
Sabrina Born
Clerk Typist
Enclosures
W riiilfJCa �1�#� f
PO.BazIl79
Town Hall,59095 Main Road
TOWN C ;�pu}bold,Pen �QNewY=vr�kS`1=1971
REGISTRAR op A o TOMICS +
o T 06315 765.5800
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FREBDO�M of T1ON OPFI
OFFICE Or C
LATZM
• TOWN OF SOUTHOLD
SOUTIKIP.klEhanrATER.DISTRICT
CONSTIO:TCTION or A AERATION PST
CESSPOOL or ,sekrnc TANK
•
VNonni . $25 Applic o111 o. 7'3 4/9
Residential Gia $10.._. or _. : 4 _.—
PtmQitNo_
Applicant Name_ PSSOlac ;=Moot'
Applicant Mailing AP. 0- 4
L . W NORK 11948
Septic •
Tom' Wil .; !/y}f
Bhe e^ ;40•110: . l ,"3.2 ....',.=; or Aket tkat
Location ofPrapo *.,.,,_
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1 I Gi41 -c.,--ftroT
Owner of Property:
OwnerM i Address: /0` J/�v Ga)SVL & 11i }3O
r
Owner Property A .ot 50 l
Laze{ /� / /f9ter
Name a contacto€ ;pe n S°2 —O /30.
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Tax Map No: Secy (2(/ Block / Lot /0
Cross Strut c ' ri
NOTE: LOCATION .MAP ` 'IL Bx susisturaww� ALIC,ATION. NEW
CONSTRUCI10N : _ '-'4
'4• APPROVAL
/07 lC---
,,. ofApp;'-' Date
Received by 5(1: ----- ..
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