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Home My WebLink AboutMinguela, Norma SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4324 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : SCOTT R. ALBRECHT Address 1: 5665 MAIN RD City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM APPROVED AS SUBMI'rrED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. Name Of Owner NORMA MINGUELA Mailing Address 1 455 BAYER RD City St Zip MATTITUCK NY 11952 Property Address 1 455 BAYER RD City St Zip MATTITUCK NY 11952 Tax Map No. section 139.00 block 3 lot 12.000 Cross Street WICKHAM AVE Building Permit Number Cross Reference: Issue Date: 6/10/15 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLE,MMC el y4 <fy�; Town Hall,53095 Main Road TOWN CLERK ;d ; P.O. Box 1179 Z ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS . . �� Fax(631)765-6145 MARRIAGE OFFICER ";\�' ! �� RECORDS MANAGEMENT OFFICER . * .i'•. �� Telephone(631)765-1800nny.go � ,• � www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER ,�,,,,•� OFFICE OF THE TOWN CLERK Fp. TOWN OF SOUTHOLD I �1 I n) ! 2015 IL:, TO: Southold Town Building Department 'a JUN 5 FROM: Carol Hydell, Southold Town Clerk's Office " "'' 'r DATED: June 4, 2015 Transmitted herewith is a copy of application No. 4324 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Scott R. Albrecht 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. RECEIVED Signature JUN 8 2015 Os- AS— Dated Southold Town Clerk 4$ 1 '',, " �,�is OFF0(�►C ELIZABETH A.NEVILLE,MMC t'x•.% ' \ lawn Hall,53095 Main Road TOWN CLERK ' o= %� P.O.Box 1179 V3 Z ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS p Fax(631)765-6145 MARRIAGE OFFICER ='j',� O�," Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER �j �� FREEDOM OF INFORMATION OFFICER � wwwsoutholdtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD June 10, 2015 Scott R.Albrecht 5665 Main Rd. Mattituck,NY 11952 RE: 139.-3-12 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 ffe, 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 ELIZABETH A.NEVILLE /, . V Town Hall, 53095 Main Road TOWN CLERK � P.O. Box 1179 Cl) Z $ Southold, New York 11971 REGISTRAR.OF VITAL STATISTICS ; Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER MARRIAGE OFFICER :=ifi /� _� At`O Telephone (631) 765-1800 f FREEDOM OF INFORMATION OFFICER =O'� * 1",,,�� 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 or Non-Residential @ $25 Application No. 3 2 / Permit No. I Applicant Name '' 2. •r�e.v-r I A , /ftB L' it I Applicant Mailing Address G-62 log m4)41 J41 A?L /fl A7-T /T7i NS l I fS2 Septic Tank tXr Cesspool Brief Description of Proposed Construction or Alteration l I JAL/4)C- P .1110V/I-r/OA) Location of Proposed Construction/Alteration: Owner of Property: 042.‘i /Y//® i9 itil 1t tLeh, Owner Mailing Address: #. tics ;r��- ,a-y_ kn /1-rr )ri1Lft ui/V. fig S-2_ Owner Property Address: AI-A Name and phone number of contact person Tax Map No: Section 13 ? Block 3 Lot / .-- Cross Cross Street L,3 ; LK k0_L1 A v"e NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVE/ ITH HEALTH DEPART NT APPROVAL Siature of pplicant at il Received by: (7-,, a Nein tVw6) �K No" 1-{ 5 piiiiogrv“ 4 641 D �'1 � h3ve / a 139 - 3 � l �