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Home My WebLink AboutMontgomery, Kevin f SCUTHCLD VIASTEVIATER D SPCCAL PER,/ T CCNSTFULTI CN CR ALTERATI CN PERM T SEPTI C TANK or CESSPOOL Per m t Pb. 4205 R Fbsi dent i al X km-Resi dent i al Fee $ 10. 00 Septic X Cesspool PERM T I SSLED TO Nacre : KE\A N & KATI LEEN NCN1(ThERY Addr ess 1: 870 SM TH DRI VE NORTH a t y St Zi p SCUTHCLD NY 11971 Descr i pt on of Proposed Const r uct i on or Al t er at i on ADD] TI CN TO EXI STI N3 SYSTEM APPRC>JED AS SU3M TTED NAI NTA] N RECD FED SETBACKS FROM ADJACENT VELLS, BU LD NGS, PROPERTY LI NES AND 1MTER BCD] ES. EXCAVATI CN I NSPECTI CN FEW FED Nacre a Omer KBA N & KATHLEEN NCNTC CIVERY Mai I i ng Addr ess 1 870 SM TH IN VE NORTH O t y St Zi p SC UTHCLD NY 11971 Pr oper t y Addr ess 1 870 SM TH DR VE NORTH O t y St Zi p SC THCLD NY 11971 Tax Mlip No. section 76. 00 bl ock 2 I of 13. 000 Cr oss Street TERRY PLACE Bui I di ng Per m t Number Cr oss Fef er ence: I ssue Dat e: 4/07/ 14 8 i zabet h A Nevi I I e Sout hold Towi Per k • ,,"of FOL t ELIZABETH A. NEVILLE,MMC 4. Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 t y Southold,New York 11971 itt REGISTRAR OF VITAL STATISTICS Fax(631)765-6145 MARRIAGE OFFICER ,•' Telephone(631)765-1800 RECORDS FREEDOM OF INFORMA ION OFFICER AGEMENT OFFICER %Ol **t oo. www.southoldtownny.gov OFFICE OF THE TOWN CLERK —__.__ TOWN OF SOUTHOLD • -`' 6 $ TO: Southold Town Building Department MAR 1 4 2013 . FROM: Carol Hydell, Southold Town Clerk's Office -- —� DATED: March 14, 2013 Transmitted herewith is a copy of application No. 4205 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Kathleen & Kevin Montgomery 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. Si ature ‘4:1/ A Dated /ofFoor , , ELIZABETH A. NEVILLE g 4.' Town Hall, 53095 Main Road TOWN CLERK ; § A.1 P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER '�� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER 41 �jo° Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER -.. jig .�a,', southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT RECEIVED •APPLICATION MAR 1 9 2013 CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Southold Town Clerk Residential @$10 or Non-Residential @ $25 Application No. Permit No. Applicant Name /1 e 0'/h �/<GL74(-tei34 ni21.7 ,-)ft.? *. PP A licant Mailing Address t 7d c a$ )to Septic Tank or Cesspool Brief Descrip 'o oposed9onstrUction or Alterajion f erS��.G Location of ProposedConstruction/ teration: Owner of Property: frg Vi vi /eA->I4/.PC�1 )4 Yl/ lvJ Owner Mailing Address: (70i")114,/ti kern c5:4 -i.oet .,f/ /17. / Owner Property Address: r70t hst- O'( .6t , Alf ' 1/7w Wii,leilee Name and phone number of contact person /SO< 73',— Tax Map No: Section l‘ Block 0 Lot / 3 6rer5" Cross Street 7Cv/, ?'-e-.-- NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY H HEALTH DEPARTMENT APPROVAL ,/2414T 3��*/3 Signature of Applicant /ate Received by: .r '/�,,o�0S�FFot�►c ELIZABETH A.NEVILLE ��h`Z` �4�; Town Hall, 53095 Main Road TOWN CLERK p , P.O. Box 1179 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER Southold, New York 11971 O �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ;y�= '� •",.1C le Telephone Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER � * �,a� southoldtown.northfork.net . OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK J Residential @ $10 Vor Non-Residential @ $25 Application No. `i XDS Permit No. /^ 1) -c.-- Applicant Name 43CerX>e2�- 076a Applicant Mailing Address le" 62c 4 zee ( /0- /` p Septic Tank or Cesspool Brief Descripof Proposed • structi t mr Alteration Location of Proposed Construction/,SAlteeratio9: r KG Owner of Property: 4 LeLe /f4 / i4o14ej Owner Mailing Address: Owner Property Address: 8 �y i`? ffipo2A 042404( 4 // 7( Name and phone number of contact person (�! Y —8 �3 Tax Map No: Section 7 - Block Lot l 3 Cross Street77 (ire iii P t' NOTE: LOCATION MAP M BE SUBMITTED WIT APPLICATION. NE CONSTRUCTION REQUIRES SURVEY WITH HEALTH D TMENT AP AL %?'"‘e (j–\/ Signature of A plic. Date Received by: I K Te ' PL .________________,.. t_ i C1 .; * , 4 , I ,, , 4 ek- ., c - .8 7 o k*4 /o f II to am o2w . cess 6 t\,( flC ' t