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Home My WebLink AboutJordan, Richard SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4091 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 RICHARD JORDAN Mailing Address 1 6075 PEQUASH AVENUE City St Zip CUTCHOGUE NY 11935 Property Address 1 6075 PEQUASH AVENUE City St Zip CUTCHOGUE NY 11935 Tax Map No. section 110.00 block 7 lot 14.000 Cross Street EAST ROAD Building Permit Number Cross Reference: Issue Date: 6/19/12 Elizabeth A. Neville Southold Town Clerk � •%gUFFoLt ELIZABETH A.NEVILLE,MMC �� Town Hall,53095 Main Road TOWN CLERK ; p ; P.O. Box 1179 t en Z Southold New York 11971 REGISTRAR OF VITAL STATISTICS O Prt Fax(631)765-6145 MARRIAGE OFFICER y `► �� Telephone(631)765-1800 RECORDS OF FREEDOM OF INAFORMATION OFFICER 'AGEMENT OFFICER Ol �a , southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TECEOWIE TO: Southold Town Building Department _ JUN 1 2 2012 FROM: Carol Hydell, Southold Town Clerk's Office BLDG.DEPT. TOWN OF SOUTHOLD DATED: June 12, 2012 Transmitted herewith is a copy of application No. 4091 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Richard Jordan 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. * * * * * * * * * * * * 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 Dated Fr IZAB 'ra A.rEVILLE �t� ri SE, Town Hall,53095 Main Road TOWN Cis o_ P.O.Box 1179 REGISTRAR OF VITAL STATISTICS sty Southold,New York 11971 MARRIAGE OFFICER • '�,�` Fax(631)765-6145 RF•COR S MANAGEMENT OFFICERV4it ilk ,.' Telephone(631)765-1800 FREEDOM OF INFOSIvIATION OFFICER = sovthcadto' i.nOrthfork.net OFFICE OF TSE TOWN CLERK • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential{}a $10 V or Non-Residential{a?,$25 Application No. Lk)!J Pent No. Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. 0. BOX 487 LAUREL, NEW YORK. 11948 Septic Tae.- or Cesspool • Brief Desi;tion o osed Constnzctioar Alteration re,yi,2&aop Gess p� n� -� ift Location of Proposed Co •on: ' Owner of Property: Qd i 0 ail O r Mailing Adder: CO 7} P- , si a1de- ( tc�it •t h V (/ '935 Owner Property Address: Name and phone number of contact person £-P�-7 ��°! � 93.z Tax Map No: Section 110 Block 7 Lot Cross Street NOTE: LOCATION.MAP MUST BE Si3BMTITT * APPLI ATION. NEW CONSTRUCTION REQUIRES SURVEY ' : :1, • y: DEPAR i:4 AP' •OV I // Sigtaiure o ..• cant Date Received by: '� J 44 11 66 ke,t4 ce444.00,J ousi, cecAr _ 1h7 ( O lo,-i AakeAr ftl Gua,S(k Cei Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/12/12 Receipt#: 135218 Transaction(s): Reference Subtotal 1 1 Septic Permit-Construct- Resid. 4091 $10.00 Cash Total Paid: $10.00 Name: Peconic, Cesspool P O Box 487 Laurel, NY 11948 Clerk ID: LYNDAR Internal ID:4091