HomeMy WebLinkAboutDrobet, Jack �� �0 Gy .
JUDITH T.TERRY Town Hall,53095 Main Road
%TOWN CLERK y Z ; P.O.Box 1179
REGISTRAR OF VITAL STATISTICS %O �, Southold,New York 11971
MARRIAGE OFFICER � • ��� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER � * 1.-es •.• Telephone(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. 1428 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
REPLACE EXISTING CESSPOOL WITH A NEW TYPE.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner DROBET, JACK
Mailing Address 1 BOX 965
City St Zip MATTITUCK NY 11952
Property Address 1 LUPTON'S POINT
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 11 lot 4.001
Cross Street MARATOOKA ROAD
Building Permit Number Cross Reference:
Issue Date: 12/15/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
41.6
**EMERGENCY - CAVE IN
/°1,���SOFFO(, ,o
• ,� y0 G :
JUDITH T.TERRY � yet Town Hall, 53095 Main Road
TOWN CLERK ; y = P.O. Box 1179
T Southold, New York 11971
REGISTRAR OF VITAL STATISTICS : O �
�'V' Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER l [l .k' ��/ Telephone(516) 765-1800
- /,
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: December 15, 1995
Transmitted herewith is a copy of application No. A1485 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Jack Drobet
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 required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
.#Sig atu r�
/"VI f c
Date
OFFICE OF THE TOWN CLERK ,,•,""'
Town of Southold �
Judith T. Terry, Town Clerk %`' Ol/ : Application No./Yu
Town Hall, 53095 Main Road = Construction L�
P. O. Box 1179
Southold, New York 11971 Alteration
O�
Telephone ,� � i $10.00 - Residential
(516) 765-1801 = 01i �, �'� $25.00 -Non-Residential L
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: of,
APPLICANT ADDRESS: Z.
SEPTIC CESSPOOL
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: 4 9c s- I s
OWNER PROPERTY ADDRESS: ---�—
TELEPHONE NUMBER OF CONTACT PERSON: (77-9Y----
TAX
29 -TAX MAP NO. : Section %/ c Block // Lot /
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE: ,
c--
Signature f Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
4 •
4
,•
-.-
/
I.'"C' 41144iitt''
."--'-' , )"I /,
/
,
/
I' )
AA)
41! .‘-------• tetril44 /
N1 itel Al -
1 -----„,- WO
tr
s 0.4.4••• • AI
(
4,,,Atte......./...„.