HomeMy WebLinkAboutPeters ELIZABETH A. NEVILLE �� ���► Town Hall, 53095 Main Road
TOWN CLERK ti P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS � � Southold, New York 11971
MARRIAGE OFFICER Ai ® Fax(631) 765-6145
w.RECORDS MANAGEMENT OFFICER ®1 �® Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
SOUTHOLD TF6YASTCW1RtMSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2675 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner PETERS, NANCY L
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Mailing Address 1 PO BOX 68
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City
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City St Zip NEW SUFFOLK NY 11968
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Property Address 1 5170 NEW SUFFOLK ROAD
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City
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City St Zip NEW SUFFOLK NY 11956
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Tax Map No. section 117.00 block 2 lot 7.000
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Cross Street OAK ROAD
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Building Permit Number Cross Reference:
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Issue Date: 10/18/01 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER a�e Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ®� ��® Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 15, 2001
Transmitted herewith is a copy of application No. 2767 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Nancy L. Peters
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.
Linda J. Cooper
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
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1
Signature
;001
Dated
I 's
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OMCE OF THE TOWN CLERK
TOWN OFSOUTHOLD �c'J CQG� Application No.Q'7(
ELIZABETH A.NEVW.E.TOWN CLERK
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 ze
Alteration
Telephone Iv,��� �Q� $10.00 - Residential
(63t) 765-1800 Ol' > $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE ldz9&'Z
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. Box 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL 1--
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit 'may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: .
OWNER MAILING ADDRESS:
vy
OWNER PROPERTY ADDRESS: Si 70
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 1/7 Block ® 2- Lot d
SSTREET: (2?clk
BUILDING PERMIT NUMBER CROSS REFERENCE:
A�
Signature of A licant
RECEIVED BY:
Town erk's Office
DATE:
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Nancy Peters
5170 New Suffolk Road
New Suffolk