Loading...
HomeMy WebLinkAboutMoore, David SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4070 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JOHN HOCKER Address 1: LATHAM SAND & GRAVEL, INC City St Zip PECONIC NY 11958 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 DAVID MOORS ------------------------------ Mailing Address 1 24 CENTRAL PARK SOUTH APT 9W ------------------------------ ------------------------------ City St Zip NEW YORK NY 10019 -------------------- -- ---------- Property Address 1 21075 SOUNDVIEW AVENUE ------------------------------ ------------------------------ City St Zip SOUTHOLD NY 11971 -------------------- -- ---------- Tax Map No. section 51.00 block 4 lot 17.000 Cross Street CLARK ROAD ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 2/23/12 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) �t o��gUFFO(�-co ELIZABETH A.NEVILLE,MMC �� Gy Town Hall,53095 Main Road TOWN CLERKp :-� P.O. Box 1179 ca Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS O Fax(631)765-6145 MARRIAGE OFFICER A� �►O a� Telephone(631)765-1800 RECORDS OF MANAGEMENT OFFICER 1 '�► southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK a TOWN OF SOUTHOLD ,� ;� L ..J TO: Southold Town Building Department lJ `=' ' 2012 FROM: Carol Hydell, Southold Town Clerk's Office �--T T 'j �a�l_D DATED: February 16, 2012 Transmitted herewith is a copy of application No. 4070 for a Cesspool/Septic Tank ALTERATION Permit submitted by: John Hocker,Latham Sand & Gravel Inc. for David Moore 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 buildin sg_, property lines and water Bodies EXCAVATION INSPECTION REQUIRED. Signature Dated E1I7.ABSTK A.NZIId.E Town Hall,53095 Main Road TOWN CIS P.O.Boz 1179 RPARSTBAR OF VITAL STATISTICSSouthold,New York 11971 MARRIAGE OFFICER 1 Fax(631)766.6145 RECORDS MANAGEMENT OFFICER Telephone(631)765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfmk zwt OFFICE OF TSE TOWN[•,T•1." TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential Q$10 -�-- or Non-Residential @$25 Application No. 4 q bl Permit No. Applicant Name Tuan - r ZA*ISM S nd+- 6rqu 1, T-aS Applicant Mailing Address 20X �© .Q.Con►r Illy /195 ' Septic Task or Cesspool Brief Description of Proposed Conshuction or Alteration ngdacQ S r� vi Location of Proposed Consbuction/Alteration: Owner of Property: �) UIC117kY)r.D Owner Alailing Address: o24- Ok)Q rft/ �r�)t dL 9 gnrL, n ci icbl Owner Property Address: 1CQ 5 5V)J thQ LJ 4V001)-Q- Nme,and pbone number of contact p,,,, bn 173 4--6 Tax Map No: /0G0 Section Jam- Block Lot rZ _ cry Sty GtA -12ba9d NOTE: LOCATION,MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY HEALTH DEPARTMENT APPROVAL s,,,/ I as12 S' of Applicant Date Received by: aA l O i D— r 1i �x 11 r t,;, `'' LS. i5 5 L5 f\l pyo ooLS �/, ew Ave.. SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4443-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner DAVID MOORE ------------------------------ �v�a Mailing Address 1 24 CENTRAL PARK SOUTH APT 9W � � Mailing Address 2 ------------------------------ O1� City St Zip NEW YORK NY 10019-0000 Property Address 1 21075 SOUNDVIEW AVE ------------------------------ Property Address 2 ------------------------------ City St Zip SOUTHOLD NY 11971-0000 -------------------- -- ---------- Owner Telephone No. 000-000-0000 ------------ Tax Map No. section 51.00 block 4 lot 17.000 ------ --- ------ Cross Street CLARK ROAD ------------------------------ ---------------------------------- Issue Date: 10/02/12Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) M. }3.:r vl Fot��, ELIZARH+ M A.NEVILLE o Town Hall,53095 Main Road TOWN 44 P.O.Bos 1179 CLERK W Southold,New York 11971 REGISTRAR OF VITAL STATISTICS • Fax(631) 765-6145 y� RECORDSMANAGEMENTTelephone(631) 765-1800' NAGEMENT OFFICER Ol �a0 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10-4or Non-Residential @$25 Application No. 7/ Permit No. Owner Name D'q mo o ,- / Owner Mailing Address a � �� `��) gam/ Owner Property Address c52/005 Sd(-)My i 2 Q ,4UQ 5:,, 4f)cio nu u9q ) r Owner Telephone No. Tax Map No: 1000 Section S Block '-- Lot Cross street clae Please check each that applies: New Construction Alteration to Existing System Residential .Non-Residential NOTE: LOCATION MAP MUST BE SUBNIITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building _ and closest road New construction may submit copy of survey with SCHD approval.) g�4 5:e, 4 X10�2&a— Sifnature of Applicant Date Lj*"n, sem 4-6r1qv.�l Received by: .�P(37130Y'6®9 • J PL S— otAA o ew ��� _ ,Ag t.J� y�Lg o �! L r /moo �S Vew Ave. ' 4