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HomeMy WebLinkAboutHart, Richard SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4088 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 HART Mailing Address 1 1900 WESTPHALIA ROAD City St Zip MATTITUCK NY 11952 Property Address 1 1900 WESTPHALIA ROAD City St Zip MATTITUCK NY 11952 Tax Map No. section 114.00 block 7 lot 12.001 Cross Street COX LANE Building Permit Number Cross Reference: Issue Date: 6/21/12 Elizabeth A. Neville Southold Town Clerk '0.e .�g11FF0[,�040 ` ELIZABETH A.NEVILLE,MMC ��0* 4• Town Hall,53095 Main Road TOWN CLERK p - % P.O.Box 1179 k :51 = ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS : O Fax 1‘,` Fax(631)765-6145 MARRIAGE OFFICER y �� RECORDS OF MANAGEMENT OFFICER -�Vl * •j►`��dl� Telephone(631)765 1800 FREEDOM OF INFORMATION OFFICER ..---- .....••••�� southoldtown.northfork.net OFFICE OF THE TOWN CLERK _____.____ TOWN OF SOUTHOLD 1 --::,'\ (i TO: Southold Town Building Department � ! JUN - 1 2012 I Li FROM: Carol Hydell, Southold Town Clerk's Office BIDG G DEFT. TOVv,OF SnTHOM DATED: June 1, 2012 Transmitted herewith is a copy of application No. 4088 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Richard Hart 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. . 71/'(--f--ve---0 ., Signature ©� a� /z. Dated t, a A.NEVU.LE ;''e = IV. Town ,53095 Main Road TOWN CLERK : a ICEGISTRSouthold,New York 11971 MAR OFRIA� fj 5.�' ,� i` Fax(631)765.6145 RECORDS� OFFICER +' Telephone(631)765-1800 f FREEDOM OF INFORMATION OFFICER =- ,,.•'' sauLholtlto'am.northforknet OFFICE OF'ME TOWN CLERIC • TOWN OF SOUTHOLD SOUTROLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK t Residential{}a $10 __ or Non Resi ent12l®$25 Application No. Li 08 cz Permit No. Applicant Name PECONIC CESSPOOL Applicant Mailing AddreSS P• 0. BOX .487 LAUREL, NEW YORK 11948 Septic Tan'- or Cesspool i/. / Brief Descl4tion ofProposed on ' ! /7P-4/72 C(7-1 , Location of Propo Co ion/ on. c? Owner of P'rope'rty: C� r� t 0 Owner Mailing Address: - '2(Owner Property Address: L ? / 1 /2e /C 1 � Lr ( Y // F5--,-- Name and phone numberof contact person -1/ i-Z — �f Tax Map No: Section 1 1 Li Block 7 Lot ) '. / Cross Street NOTE: LOCATION. MAP MUST BE samara, APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITIi s :/, 5i'AR. ROV 7'7- ' S.nt '1"4 0 4 „L 2 Ott Date CL-Q _ . Rece;ved by: R" A kA)4 1700 f8`