HomeMy WebLinkAboutSturcken, Anthony SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 4087 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
WELTS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner ANTHONY STURCKEN
Mailing Address 1 36925 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 36925 MAIN RD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 85.00 block 2 lot 12.003
Cross Street SKUNK LANE
Building Permit Number Cross Reference:
Issue Date: 6/18/12 Elizabeth A. Neville
Southold Town Clerk
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ELIZABETH A.NEVILLE,MMC efp#1�. �Gy•
Town Hall,53095 Main Road
TOWN CLERK p P.O.Box 1179
y Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS . W
O ` Fax(631)765-6145
MARRIAGE OFFICER
RECORDS OF MANAGEMENT OFFICER .,. `�� �� Telephone(631)765 1800
FREEDOM OF INFORMATION OFFICER ,• southoldtown.northfork.net
OFFICE OF THE TOWN CLERK nJ�
TOWN OF SOUTHOLD
TO: Southold Town Building Department _ MAY 3 1 2012
FROM: Carol Hydell, Southold Town Clerk's Office BIM DEPT.
TOY',PT ,PPTHOLD
DATED: May 31, 2012
Transmitted herewith is a copy of application No. 4087 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Anthony Strucken
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.
2144(•'4-75e,
Signature
a 0 /2._
Dated
�'� TH A.Z VILLE i'' Town Gall,53095 Main Road
TOWN CLIMEP.O.Boa 1179
0" _ : Southold,New York 11971
��MIME �TAL STATISTICS ''',10 `�` Fax(631)7654145
=COEDS IdAN t t Telephbrle(631)765-1800
FREW=OFn ATION0FP`ICER = * . ,,; Id�s.nortizfork.net
OFFMOE OF TEE TOWN cizzat
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
i
Residential(4$10L or Non-Residential @$25 Application No. 9 0 7
Peat No.
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P. 0. BOX.. 487
LAUREL NEW YORK 11948
Septic Tom:.-`___or Cesspools -}
Brief es tion of Construction tuation
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Location of Proposed . . ,-; Aon:
Owner of Property: do , o L�- c -c-ke o
Owner Mailing Address:
Owner Ate: 3 / Z 5- PILZ&?Properykj.
- Ori 'L '- ( At Y. 11835
Name and phone number of contact . - . his/ems" 57 _ef��
Tax Map No: Section gs, Block Lot 124_3
Cross Stmt -.S -tAv, Lov �
NOTE: LOCATION MAP MUST BE SilawnTRD wan APDL€' TION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEAL +'s ) :4 AR
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