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Home My WebLink AboutHorton, Debra (2) pF SO!/l ELIZABETH A. NEVILLE �.I4� y�lO Town Hall, 53095 Main Road TOWN CLERK411 ; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS y Southold, New York 11971 MARRIAGE OFFICERQ �� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER q4. ,�Q1� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER COUri *V-66° southoldtown.northfork.net o... • •• OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4356-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner DEBRA HORTON Mailing Address 1 970 ROUTE 25A Mailing Address 2 City St Zip MILLER PLACE NY 11764-0000 Property Address 1 3205 DUCK POND Property Address 2 City St Zip CUTCHOGUE NY 11935-0000 Owner Telephone No. 631-744-5000 Tax Map No. section 83.00 block 1 lot 1.500 Cross Street Issue Date: 9/05/07 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ,,,,,,,,,, ELIZABETH A.NEVILLE ' Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS N,O� ``fo Southold, New York 11971 MARRIAGE OFFICER V'' ,/' Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER \- Os/1 * *to Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER `- ,,,,.�''� aoutholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 ✓ or Non-Residential @$25 Application No. 33 ka k Permit No. * LI 35c Owner Name 066g4 1-624-0N Owner Mailing Address q?O as-4 htiL d3 kiirc6r Lx tl76.T Owner Property Address 5AI)4 3x35ISISc,k Pcna 'Rd. CixChOC U - Owner Telephone No. C3 1- cOOO Tax Map No: Section b 3 • ou Block I Lot r S. ova Cross Street 1J<SPLArGG' Please check each that applies: New Construction ✓ Alteration to Existing System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) .� � vs_A7 Signature of Applicant Date Received b .1101s& ` • _ 4 go %pF SOUr'SOl0 ELIZABETH A.NEVILLE 11��•• �O Town Hall,53095 Main Road TOWN CLERK 4[ P.O. Box 1179 cn Southold, New York 11971 G REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER �'�► . ,� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �,'1,�`,COMM �16• Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER . DU111�, ,,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 27, 2005 Dear Sir/Madam: Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars ($10.00) for a residential system and twenty-five dollars ($25.00) for a non- residential system. Your check should be made payable to the "Southold Town Clerk". An application form is enclosed. Please complete the requested information and return the application, proper fee, and LOCATION MAP (map must indicate the location of the cesspool(s)/septic tank(s), giving approximate distances in feet from any buildings to the pools and distances between the pools. Should you have any questions concerning this matter, please do not hesitate to contact this office. Very truly yours, Lynda M Bohn Account Clerk Enclosures • o', _Apf S004 ELIZABETH A.NEVILLE / '`� Town Hall, 53095 Main Road TOWN CLERK 1 P.O. Box 1179 H Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 1,�'`, �� Fax (631) 765-1800 FREEDOM OF INFORMATION OFFICER OUI11�, ,,.' southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3382 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : DEBRA HORTON Address 1: C/O CRAMER CONSULTING GROUP City St Zip MILLER PLACE NY 11764 Descripton of Proposed Construction or Alteration -SINGLE FAMILY DWELLING 36' X 44', IRREGULAR -FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT Name Of Owner DEBRA HORTON Mailing Address 1 1465 PINE TREE ROAD City St Zip CUTCHOGUE NY 11935 Property Address 1 3205 DUCK POND ROAD City St Zip CUTCHOGUE NY 11935 Tax Map No. section 83.00 block 1 lot 15.000 Cross Street VISTA PLACE Building Permit Number Cross Reference: 11 Issue Date: 10/27/05 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL)