HomeMy WebLinkAboutLavin, George • e„•
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ELIZABETH A. NEVILLE ��� Town Hall, 53095 Main Road
TOWN CLERK ; y • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS V' Southold, New York 11971
MARRIAGE OFFICER .�,fiL ����, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Q" a0',� 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
l"'ermit No. 2357 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT IS SUED TO:
Name : PECONIC CESSPOOL
Address 1 PO BOX 972
City St Zip MATTITUCK NY 11952
)escripton 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.
EXCAVAT±.JN INSPECTION REQUIRED.
Name Of C Amer LAV I N, GEORGE
Mailing Address 1 .53 AMAGANSETT DRIVE
Crty St Iii SOUND BEACH NY 11789
Property , ddress 1 3865 GRAND AVENUE
City St z`° MATTITUCK NY 11952
Tax Map r ). section 107.00 block 1 lot 4.001
Cross Stn.. t
B gild g i ., mit Number Cross Reference:
Issue Date' 7/07/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
u 357
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JUN 2 8
2000 0•oil s FFO r
ELIZASET �� h # ; Town Hall, 53095 Main Road
TOWN JSC p -i D ` y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
ie. Pr, tSouthold, New York 11971
MARRIAGE OFFICER ��,fiL ���I,, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '/Ql �a0 iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - ............:sur,
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 27, 2000
Transmitted herewith is a copy of application No. 2445 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for George Lavin
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. •
y ----Signature
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OFFICE OF THE TOWN CLERK s ���D1.K
TOWN OF SOUTHOLD ��''��J �QG= • Application Nod Y5
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 1,t
Construction (--
SOUTHOLD,NEW YORK 11971 ;
Alteration
Telephone ij� NO
Q ';� $10.00 -Residential /___/(63t) 765-1800
-• $10.00
4 0,�� $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for QPCEIVED
CONSTRUCTION or ALTERATION PERMIT JUN 2 7 2000
SEPTIC TANK or CESSPOOL rs.,.,thoid fown Clock
Permit No.
Fee .$ f/49/DATE - y
APPLICANT NAME:
(-11211- ff)L1
APPLICANT ADDRESS: /4? 9 77!
•
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTER TIQN:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: --aaG S—'
OWNER PROPERTY ADDRESS:
LM.t to % i—
TELEPHONE NUMBER OF CONTACT PERSON: r
TAX MAP NO. : Section I 07 Block
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CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature of Appli ant
RECEIVED BY:
Town Clerk's Office
DATE:
55
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