HomeMy WebLinkAboutMattituck Presbyterian Church (3) AP
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ELIZABETH A.NEVILLE , y� l/,y� Town Hall, 53095 Main Road
TOWN CLERK �� 1 r P.O. Box 1179
t 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS . Fax (516) 765-1823
MARRIAGE OFFICER •
RECORDS MANAGEMENT OFFICER y 0. Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER -'/�� l �`����
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 90 N Residential Non-Residential X
Fee $ 25.00 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 OLD CESSPOOLS WITH NEW TYPE TO EXISTING SYTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner MATTITUCK PRESBYTERIAN CHURCH
Mailing Address 1 12605 MAIN ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 12605 MAIN ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 4 lot 314.000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Th.4
Issue Date: 4/16/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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SUFFOtA-�;
ELIZABETH A.NEVILLE l . �l/,y� Town Hall, 53095 Main Road
TOWN CLERK ,� o < ,. P.O. Box 1179
CI, - Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % T Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER r4,1 ��& Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER -_ �'li ',.�a""
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 12, 1999
Transmitted herewith is a copy of application No. 2136 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Mattituck Presbyterian Church .
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.
r5l`cam
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.
ignatur
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Date
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OFFICE OF THE TOWN CLERK
• Town of Southold .,.."c)\\I'V iltirt.9-....
No.03/3A0 ,
Judith T. Terry, Town Clerk tk' , ett:.% Application
Town Hall, 53095 Main Road ,? '.4L :4 .1" Construction
P. 0.0. Box 1179 : M
Southold, New York 11971 Alteration
Telephone
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,a. Ø0 -- Re=;idential•
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(516) 765-1801 $2 c ,(7:Non Resical__
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SEPT iC TAN r t (...'j ,, I ( ut_
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Permit No.
Fee $
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APPLICANT NAME : .
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. APPLICANT ADDRESS. # .0 7.34Are ??2...
'7-72-1,•(.64,tee,4-11.
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SEPTIC CESSPOOL 'I.'''.
DESCRIPTION OF PROPOSED CI)Ns-i-Ri)( 1 :01.-,: OR AL. TEFA'T ION •
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LOCATION MAP. Mt be aZtv.it)e(i het etc, Ir,o'r_li ,. !,et )rl,t inz.t), be issued 1. --
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LOCATION OF PROI'OSE1) CI:INS T. I.O.'?..2 r U) .4 O id 7 E'tikl- t0 :
OWNER OF PRCIPET' l l' • , .
OWNER MAILING ADDRESS: /2.... 4POSI- Pie-i.i..4.- t .,./1_.--1LI__ ____ — -- •
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OWNER PROPERTY ADDRESS: tg........, . ..-......---,------.-.......-........ ,,z,
TELEPHONE NUMBER OF CONTACT PERSON :
________ ,.2;
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444
TAX MAP NO. : Section i yi 131oci< _14 — ---Cot ---l__. ; •
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Gli1.43543--STREET: ofeialteiv t-441(4.1.4( 41,!,..„r__ —, ,••: ,_,„••:,,,;,.:
BUILDING PERMIT NUMBER CROSS REFERENCE :
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