HomeMy WebLinkAboutMattituck Presbyterian Church (4) ',��,o �fFO��coG,\
ELIZABETH A.NEVILLE d i`1` tot ; Town Hall, 53095 Main Road
TOWN CLERK p :g• P.O. Box 1179
ti = ; Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ;O .���, Fax (516) 765-6145
MARRIAGE OFFICER ` Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER �JJO Ol 1�� P
FREEDOM OF INFORMATION OFFICER : 1 4 *-0„,••
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 93 N Residential Non-Residential X
Fee $ 25.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MATTITUCK PRESBYTERIAN CHURCH
Address 1 : 12605 MAIN ROAD
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
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 114.00 block 9 lot 5.000
Cross Street SOUND AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/05/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE 1tgsi$ t; Town Hall, 53095 Main Road
TOWN CLERK t o .:4 % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
VVvO. 4 ���� Southold, New York 11971 Fax (516) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER `\y�f� aO�''�� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER '� '��°
-• • gel
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: September 27, 1999
Transmitted herewith is a copy of application No. 2252 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
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.
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. 2ignatur
Date
OFFICE OF TOWN CLERK ,''' ���Or� _
TOWN THEOF TOHOLD �_Q� Appli • No. 37-2
F117ABErH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 ► Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone $10.00 -Residential
(516) 765-1801 tir $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
APPLICANT NAME: A1,/T1,7•11Cr /9SAYThR)4A. c4/UAC/!
APPLICANT ADDRESS: Id key' A14i/1/ R(740 /l/� ,7-'T0-•Uc/'( PI
SEPTIC / CESSPOOL /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Rg-Pt -C/Lc E)L /STin- c Pd0G
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /14/37 f -rveif p eergmndpi 't chivec�
OWNER MAILING ADDRESS: /.2h,oS 'i4,j RD, ," Oe.l3 DOC /SW
/44 -(��sr tiY // 45-.2
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 765- 3> 7/
TAX MAP NO. : Section /RI Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
c7#4----4 __
Signature of Applicant
RECEIVED BY:
o n Clerk's Office
DATE: ?( ,(77
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