HomeMy WebLinkAboutSeyfried, Timothy • ,,•,/iii,-
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ELIZABETH A. NEVILLE '��h # ; Town Hall, 53095 Main Road
TOWN CLERK - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v' Southold, New York 11971
MARRIAGE OFFICER :�4' ���1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Ql *A. �,i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - •1
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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. 2355 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner SEYFRIED, TIMOTHY & DOREEN
Mailing Address 1 PO BOX 243
City St Zip MATTITUCK NY 11952
Property Address 1 75 FACTORY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 142.00 block 1 lot 9.000
Cross Street WALNUT ROAD
Building Permit Number Cross Reference:
Issue Date: 6/28/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLIE`" ` yd 1 Town Hall, 53095 Main Road
TOWN CLERK • P.O. Box 1179
"'T bt Southold, New York 11971
REGISTRAR.OF VITAL STATIB,'�'��5,; SCUM()AI 7.- Fax (631) 765-6145
MARRIAGE OFFICER--
RECORDS MANAGEMENT OFFICER _"'/O �D�
� li�, Telephone (631) 765-:L800
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: June 26, 2000
Transmitted herewith is a copy of application No. 2443 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Timothy& Doreen Seyfried
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
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
(0I / o
Dated
OFFICE OF THE TOWN CLERK .I"'C f OUr
ill �QG= Application No. o i-i s
TOWN OF SOUTHOLD ,,
FT 77ABETH A.NEVILLE,TOWN CLERK ���,,,
P.O.BOX 1179 Construction (/
SOUTHOLD,NEW YORK 11971 Z
z Ca ^' t Alteration
s cis $10.00 - Residential v
Telephone ��j,�j �0,"(516) 765-1801 = Ol ��,," $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 45/11)
0
APPLICANT NAME:
APPLICANT ADDRESS: 77 2.--
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION �/
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERAT N:
OWNER OF PROPERTY:2`f �''�.CGl.L �/f1 --
OWNER MAILING ADDRESS: PA /, _2J3
/17, '7.7"yri:v�c-
OWNER PROPERTY ADDRESS: 7 S� ,/fL 7`a/Lf- At/&-
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 4/c12- Block / Lot , /
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature o Appli jnt
RECEIVED BY:
Town Clerk's Office
DATE:
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