HomeMy WebLinkAboutBruer, Debra SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4131 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 DEBRA BRUER
Mailing Address 1 P 0 BOX 1874
City St Zip SOUTHOLD NY 11971
Property Address 1 505 FOX HOLLOW ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 6 lot 17.000
Cross Street RACCOON ROAD
Building Permit Number Cross Reference:
Issue Date: 12/27/12 Elizabeth A. Neville
Southold Town Clerk
�G : Town Hall,53095 Main Road
ELIZABETH A. NEVILLE,MMC ,������elei y ;
TOWN CLERK ; o= P.O.Box 1179
1 y 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p .F 0 Fax(631)765-6145
MARRIAGE OFFICER 4. 0*��� Telephone(631)765-1800
RECORDS MANAGEMENT
www.southoldtownny.gov
FREEDOM OF INFORMAION OFFICER --'",.,.,.00
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
lEMWE
TO: Southold Town Building Department DEC 2 4 2012
FROM: Carol Hydell, Southold Town Clerk's Office
BLDG. DEPT.
TOWN OF SOUTHOLD
DATED: December 24, 2012
Transmitted herewith is a copy of application No. 4131 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Debra Bruer
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. .
?ZU:x. 7i&
/� — /L--
Dated
ELi?,, TS A. ;''; > Town Hall,53095 Main Road
owN CLAS - P.O.Box 1179
REGISTRAR orvim STAT cS ;. Southold,New York 11971
` Paa(631)7654145
BSCo8D6MANAGE 'IME A , T ephone(631)765-1800
PB m=OF 3XFORWIASTON OFFXCE t * �III
Id vn.northfork aet
OPIUM M OP DM TOWN Cid
• TOWN OF SOI3TliOLD
SOU'IOLD WASTEWATER DISTRICT
. APPLICATKM
CONSTRUCTION or ALTERATION'PERMIT
CAUL or sziencTANK
Residential @$10 V or Non-Residential @$25 ApplicationNo. ' ) 1
Permit
Applicant Name PECONIC CESSPOOL
Applicant Msiiing.Addxess P• a. BOX_487
LAUD NEW YORK 11948
Septic Tom- or Cesspool y/
Brief Desc:ption of Proposed • .,i :r;. i or Alteration,
j ,o-,,j, r ce 55/70- --
Location ofProposed. o ,rya a s<a o IA1
Owner of Property: e o ra, Otfruces--
Owner
Maung Address:
"5-0Address: T. FoX JotJ 'A
Owner Property t
ir
f11G7 y l /'
Name and phone number of contact person L2 5 i --4 7
Tax Map No: Sect, I I S1 Block Lot / .?
cross Street )V i' XG,Ccc 0/4
NOTE: LOCATION-MAP MUST BE SUBMIT= ' : APPLICATI s N. NEW
CONSTRUCTION REQS SURVEY wiTH HEALTH f'z4' `T1ViEENT : 'A' "s VAL
/G
&paten of ' t•t i',..- it Date
Received by: .
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