HomeMy WebLinkAboutDavid, Arthur 000.t\ 00
JUDITH T.TERRYyl Town Hall, 53095 Main Road
TOWN CLERK N = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O
Southold,New York 11971
MARRIAGE OFFICER y� ���1�, Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �llig `t►��d� Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER ��,,,.•��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1399 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 CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner DAVID, ARTHUR
Mailing Address 1 3825 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 3825 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 137.00 block 1 lot 3.001
Cross Street TRACK AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/17/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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• JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK t/s Z ; P.O.Box 1179
Pri
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �` -y �1 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER
MARRIAGE OFFICER L .V1 ��l� Telephone(516)765-1800
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FREEDOM OF INFORMATION OFFICER '0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department 1 1995
FROM: Linda Cooper, Southold Town Clerk's OfficeBLD
DATED: October 11, 1995GSOUTNOt.[)_
TOWN OF.. .�
Transmitted herewith is a copy of application No. A1453 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Arthur David •
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.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain re uired setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature /
4
Dat'
x 1
OFFICE OF THE TOWN CLERK ,,,'"',"
Town of Southold ,''�'O' C))F-O(Kl'OG Application No./414S
Judith T. Terry, Town Clerk ; y'
Town Hall, 53095 Main Road Construction
P. O. Box 1179rn
Alteration
Southold, New York 11971 -
Tele hone "IV
Q� '� $10.00 - Residential Z�
p
(516) 765-1801 .�l * �;, ' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: y
APPLICANT ADDRESS: v • 72._.
f 1/ 957-
SEPT I L CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
moi,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION ! ' ALTERA ION:
OWNER OF PROPERTY: �� ��/
OWNER MAILING ADDRESS: .3 O c-c
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: c`-7 96.
TAX MAP NO. : Section / 37 Block 7 Lot 2 , /
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
,41'14/6
Signature of Appli. nt
RECEIVED BY:
Ria Cle k's Office
DATE: OCT t 't 1995
town clerk Southold
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