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HomeMy WebLinkAboutHartung, John SCUTHCLD MASTEMATER CI SPCSAL PERM T CCNSTRLICTI CN CR ALTERATI CN PERM T SEPTI C TANK or CESSPOOL Per m t Nb. 4247 R faesi dent i al X N n-Rlesi dent i al Fee $ 10. 00 Septic X Cesspool PERM T I SStJED TQ Nene : PECCN C CESSPOOL Address 1: P O BC)C 487 City St Zip LAJREL NY 11948 Cescr i pt on of Proposed Const r uct i on or Al t er at i on APPFCMED AS SWM TIED MPJ NTAJ N RECD FED SETBACKS FRiCM ADJACENT V'ELLS, BU LI] N26, PROPERTY LI NES AND MATER BCD ES. EXCAVATI CN I NSPECTI CN FEW RED Name a Omer J a-N HARTUVG Mai I i ng Address 1 P 0 BCC 118 a t y St Zip NEW SL FOLK NY 11956 Property Address 1 150 BUWY LANE a t y St Zi p NEIN St FC LK NY 11956 Tax Map Nb. section 117. 00 bl ock 6 I of 26. 006 Cx oss Street NEW SU=FCLK AVENLE Bui I di ng Per m t Number Cr oss Ref er ence: I ssue Dat e: 7/22/ 14 El i zabet h A Nevi I I e Sout hold Tow a er k (TOM SEAL) ,,,ice , �SUFF014' ELIZABETH A. NEVILLE,MMC � � o Gy• Town Hall,53095 Main Road TOWN CLERK ; = ; P.O. Box 1179 y = ; Southold,New York 11971 REGISTRAR OF VITAL STATISTICS `O Fax(631)765-6145 MARRIAGE OFFICERL y `► �� RECORDS MANAGEMENT OFFICER ��i� Telephone(631) 765 1800 FREEDOM OF INFORMATION OFFICER ,i�� www•southoldtownny.gov OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD J I I( 1 7 2014 TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: July 17, 2014 Transmitted herewith is a copy of application No. 4247 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for John Hartung 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 7/.6/ Dated surruyr ��lj ; Town Hall,53095 Main Road E U ZABtra A.3�NE vraz 't� TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTiCs : v f Southold,New York 11971 MARRIAGE OFFICER 'Ft�` Fax(631)765-6145 RECORDS MANAGEMENT OFFICER =_ � ,`► Fax (631)765.1800 •' FREEDOM OF INFORMATION OFFICER . ' southoldtown.northfork.net OFFICE OF TSE TOWN CLERK • TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential®$10 or Non-Residential®$25 Application No. 142Ln • Permit No. Applicant Name PECONIC CESSPOOL Applicant Mailing Address P. 0. BOX 487 LAUREL, NEW YORK 11948 Septic Tat or Cesspool , Brief es�( VPraposed Co�ns't1ructqAlteration amS AqAA _ . Location of Proposed Cons Alteratio Owner of 0• � �'� Owner Maing Ad• . �0 \--& . \\ Owner Property Address: 1 5-o ,, gig Z-0.14e- • V/IlY //95--C Name and phone number of contact person (a .CrTax Map No: Section \ fl Block CP Lot Q10 - Cross oss Street NOTE: LOCATION.MAP MUST BE SUBMITTED ' : APPLI Ok ON. W CONSTRUCTION REQUIRES SURVEY ` y :1 AL ' :% EPAR i 31'1'PR VAL if 7f5// 'gnature v ••licant Date Received by: V -.6- S Vv ©GA GessceSS�Oo�/S 37 c 5-0 00ff o+/l Ce9 o.oi 0 .� (4,101).1LOVIAR, r * * * RECEIPT * * * Date: 07/17/14 Receipt#: 175033 Quantity Transactions Reference Subtotal 1 Septic Permit-Construct- Resid. 4247 $10.00 Total Paid: $10.00 Notes: Payment Type Amount Paid By CASH $10.00 Peconic, Cesspool Name: Peconic, Cesspool P 0 Box 487 Laurel, NY 11948 Clerk ID: LYNDAR Internal ID:4247