HomeMy WebLinkAboutKophen, James JUDITH T. TERRY ; :1C Town Hall, 53095 Main Road
TOWN CLERK •
• P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : : Southold, New York 11971
MARRIAGE OFFICER Vv` �. Fax (516) 765-1823
1� Q �� Telephone (516) 765-1801
' `.,,,,'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 792 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 AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10' SEPARATION AND CALL FOR AN EXCAVATION
INSPECTION.
Name Of Owner KOPHEN, JAMES W.
Mailing Address 1 P. O. BOX 1201
City St Zip SOUTHOLD NY 11971
Property Address 1 CEDAR DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 77.00 block 1 lot 3.000
Cross Street OAK AVENUE
Building Permit Number Cross Reference:
Issue Date: 1/07/92 Judith T. Terry
Southold Town Clerk
(TOWN SEALI
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JUDITH T. TERRY �� 0 `: Town Hall, 53095 Main Road
TOWN CLERK Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS : rT Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
0 �� �� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
MIND
December 27, 1991
To: Southold Town Code Enforcement Officer JAN 02 P '
CM NOW
From: Linda J. Cooper, Southold Town Clerk's Office Tern
Transmitted herewith is a copy of application No. A813 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for James W. Kophen
•
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: 14.4.1LA j p', q�c .e�lu y hu
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Date
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OFFICE OF THE TOWN CLERK �,,,'"',,"
Town of Southold .''� �Ff ,f1 .3
CApplication No.
D
Judith T. Terry, Town Clerk �'� Gy "
Town Hall, 53095 Main Road ;� Construction
P. O. Box 1179 : c • T Alteration
Southold, New York 11971 cn 1 �•`
Tele hone y0 V- $10.00 - Residential
(516) 7p65-1801 ���l
$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 1;1 ki
APPLICANT NAME: `
APPLICANT ADDRESS: 972--
SEPTIC
72SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Jr.,/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
"go. 160)1
OWNER MAILING ADDRESS: /2 d/
i - //9 7/
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 77 Block / Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Ap icant
RECEIVED BY: ��,,,�pp®®
Town CIA N'S'V'ITice
DATE: - DEC 271q°1
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