HomeMy WebLinkAboutKoch Holdings Corp Inc SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4115 N Residential Non-Residential X
Fee $ 25.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : KOCH HOLDINGS CORP, INC
Address l: P 0 BOX 37
City St Zip MATTITUCK NY 11952
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 KOCH HOLDINGS CORP, INC
Mailing Address 1 P 0 BOX 37
City St Zip MATTITUCK NY 11952
Property Address 1 95 FACTORY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 122.00 block 6 lot 9.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 12/04/12 Elizabeth A. Neville
Southold Town Clerk
, ,,O��gUFFO(,�Co
ELIZABETH A.NEVILLE,MMC � <($. \ Town Hall,53095 Main Road
TOWN CLERK p P.O.Box 1179
t ti Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS %%".°4;*
00 �t
O Fax(631)765-6145
MARRIAGE OFFICER 4J' ��
� i Telephone(631)765-1800
RECORDS OF MANAGEMENT OFFICER '9j �►a �0i p
FREEDOM OF INFORMATION OFFICER �� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD D (Z C (E D W 2
TO: Southold Town Building Department _ OCT — 3 2012
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FROM: Carol Hydell, Southold Town Clerk's Office
BLDG.DEPT.
DATED: October 3, 2012 TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No. 4115 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Koch Holdings Corp
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.
Signature
/0 Dated F/42--
fr
MAZA.1311711 A.NEVILLE ti''4 � , Town Hall,53095 Main Road
ck-
TOWN azzE0 ` P.O.Box 1179
REGISTRAR or IAGITAL ICER STATISTICS Southold,New York 11971
MARRIAGE OFIt'i{3 & ,� Fa:(631)763.6145
RECORDS a682 itT ,0 T one(631)765-1800
MEEDOM OP IN OEI3ATION OFFICER = '
,;.•' aoutiioldtflwn.norLhforkaet
OESICM OF TUE TOWN CLERK
• TOWN OF SOiOLD
SOUTHOLD WASTEWATER DISTRICT
A 'I `ANON
CONSTRUCTION or ALT/RATION PERMIT
CESSPOOL or SKPITC TANK
Residential®$10 , or NOU-Residential g$25 V Application No. 't I 1 5 •
Permit 1o.
Applicant Name PHCONIC CESSPOOL
Apples Mailing.Address P. O. BOX.487
LAIRE4, NEW YORK 11948
Septic Tat:- or Cess •
Brief Des :ption of Proposed stn on or • _- -H.
faeSS11 , . -
Location of Proposed Construction/Alteration.:
Owner ofProperty: KOC) 7o/ d'tis Corp 1r)C
Owner M2ffing AddressX.5" c z
e bX 37
4/fft77,15 u pry 1195
Owner Address: 95--- F��� , G.iUe,-
C/ fry (/95--oe
Name and phone number of contact person Les 57,--N9-893c,
Tax Map No: I a Z Block Lot 9
cross street7 -
NOTE: LOCATION MUST BE SUBMITTED 4 = APPLICATION. NEW
CONSTRUCTION �S S€ VEY Wf lH HEAL z 'Signature of •N* , 2; Date
Received by: ve,q,/
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