HomeMy WebLinkAboutBurkhardt, Rose W $ Town Hall, 53095 Main Road
V �4,-i P.O. Box 1179
� I Southold, New York 11971
JUDITH T.TERRY =1...v."01'�� FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1195 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 NEW OVERFLOW POOL TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. NOTE: CALL FOR INSPECTION BEFORE COVERING.
Name Of Owner BURKHARDT, ROSE
Mailing Address 1 THIRD STREET
City St Zip NEW SUFFOLK NY 11956
Property Address 1 THIRD STREET
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 7 lot 15.000
Cross Street KING STREET
Building Permit Number Cross Reference:
Issue Date: 5/12/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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.JUDITH T. TERRY �'���������, TELEPHONE
TOWN CLERK
(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A506 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Rose Burkhardt
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you. ��
Gare .. E`-.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed r
above and make the following recommendation:
APPROVE - X
DISAPPROVE -
COMMENTS: n - .V►'t.tt civet g1tica (ca'a&Lk) , o
1A-fL30.4$‘.
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Signature
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Date
OFFICE OF THE TOWN CLERK %5ItFU
Town of Southold j ' (1 ' Application No. ,-:-J6/ 7
Judith T. Terry, Town Clerk
Town Ball, 53095 Main Road Construction
P. 0. Box 1179
Southold, New York 11971 4Alteration
Telephone _°./ �.a� Residential
(516) 765-1801 '"
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. L/93--
Fee
`,Fee $ A9"J
DATE 5/N4/9
APPLICANT NAME: 1,9-Let. 61--1/197-r
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APPLICANT ADDRESS: /-,G�< �/ R72-
SEPTIC CESSPOOL ,''
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERA 10
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 7$1* Laee
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OWNER PROPERTY ADDRESS: f yyt '
TELEPHONE NUMBER OF CONTACT PERSON: G79 9f 2‘.--5=.0
TAX MAP NO. : Section // 7 Block 7 Lot /f
CROSS STREET: j ���( `S'
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Ap•fi ant
RECEIVED BY: 64- -ef--,--;2
RECEIVEDvn Clerk' Office
DATE:
MAY 11 1989
town clerk Sona*
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