HomeMy WebLinkAboutBooth, Helen r !
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ELIZABETH A.NEVILLE _ � Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` Southold, New York 11971
MARRIAGE OFFICER `� •fi l�� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER -_ O( $•1*011 Telephone (631) 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. 2465 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HELEN BOOTH
Address 1 : PO BOX 23
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
REPLACE EXISTING CESSPOOL WITH NEWER ONE.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner BOOTH, HELEN
Mailing Address 1 PO BOX 23
City St Zip PECONIC NY 11958
Property Address 1 405 FASBENDER AVENUE
City St Zip PECONIC NY 11958
Tax Map No. section 67.00 block 6 lot 5.000
Cross Street THIRD AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/20/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
Ole OFF 014. ; J
e ,ZO
ELIZABETH A. NEVILLEI�� Gy<: Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �` y 4�1�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ; 701jit .0,01' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 13, 2000
Transmitted herewith is a copy of application No. 2553 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Helen Booth
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE V
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
l� lllod
Dated
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OFFICE OF THE TOWN CLERIC 1'! y�c�Otir
TOWN OF SOUTHOLD 1"' S Ql/. Application No. �533
ELIZABETH A.NEVI LE,TOWN CLERK ;�: ' /
P.O.BOX 1179 : ��` ; Construction
SOUTHOLD,NEW YORK 11971 : OT ;
to Alteration
Telephone � $10.00 - Residential
(631) 765-1800 - 1 *�;,0�'� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE // / 3 - DD
APPLICANT NAME: e Lp yk 661-014,
APPLICANT ADDRESS: I-ID f t ' 1-,..ev‘ d.,P -t it� e, (,0.C, n�
SEPTIC CESSPOOL x
DESCRIPTION OF PROPOSED CON �
STRUCTION OR ALTERATION V`
-�Is�'Inc' Cc�V 9ej �ry �C� c . trt Lie
LOCATION. MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: q•ei,e y C
OWNER MAILING ADDRESS: 405 FCS t7e1,, N I O$ Z3
Ic 11 I Ig J
OWNER PROPERTY ADDRESS: Ltos FQs �pp p,L ch,A.
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section (.o-1 Block (p Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
e
Signature of Applicant
RECEIVED BY: AL
Town C'erk's O ice
DATE: / 041/1 /4,401"
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