HomeMy WebLinkAboutBoursiquot, Ange (2) ,�o��FFOLKCOy
L Town Hall, 53095 Main Road
JUDITH T. TERRY ►►
i ` P.O. Box 1179
TOWN CLERK G rTt
REGISTRAR OF VITAL STATISTICSf) Southold, New York 11971
MARRIAGE OFFICER ‘y0` •' Fax (516) 765-1823
----AO 0 1� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 905 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF A NEW OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED.
Name Of Owner BOURSIQUOT, ANGE
Mailing Address 1 100 BEEKMAN
City St Zip NEW YORK NY 10038
Property Address 1 MAIN ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 122.00 block 6 lot 15.000
Cross Street FACTORY AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/18/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : Z -411, Town Hall, 53095 Main Road
TOWN CLERK v T 1 s _, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS •tr W c Southold, New York 11971
MARRIAGE OFFICER y0 ��, Fax (516) 765-1823
=:',y0 �.$��� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 2, 1992
Transmitted herewith is a copy of application No. A 929 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Cesspool for Ange Boursiquot •
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.
•
Akt\~ r
Linda J. Cooper
* 4 * * * * * * * * *
I _itt
h reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE D(
DISAPPROVE • nn ,, ((11 iftil
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Signature
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Dated
OFFICE OF-THE TOWN CLERK ,,,'",,,"
Town of Southold s,."4OLI(
C6 Application No. 9
Judith T. Terry, Town Clerk �� � G�;
Town Hall, 53095 Main Road Construction
P. O. Box 1179 o k T
Alteration
Southold, New York 11971 •tta ��`
Telephone ;moo AT, $10.00 - Residential t--
(516) 765-1801 l sW
$25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
RECEIVED for
SEP t O RUCTION or ALTERATION PERMIT
$outhoidT0WnC16d4PTIC TANK or CESSPOOL
Permit No.
Fee $
DATE (
APPLICANT NAME: Ak7ee ®•'✓i �
APPLICANT ADDRESS: 6-Ole 97i-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CO STRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: "V/t/7-4 .4 4I-
OWNER MAILING ADDRESS: /0V
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OWNER PROPERTY ADDRESS: �w ‘41‘4.50b71_1
TELEPHONE NUMBER OF CONTACT PERSON: c7W---96Sk
TAX MAP NO. : Section 12..2- Block 6' Lot /r
CROSS STREET: -tom
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applica
RECEIVED BY:
ownerk' Office_l
DATE: �� 1 _
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Pecomic eeetspoal
SEWER& DRAIN SERVICE
P 0. BOX 972 BRAY AVENUE MATTITUCK, NEW YORK 11952
(516) 298-9658
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