HomeMy WebLinkAboutPike, Robert , �Og�FFO�,�
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ELIZABETH A. NEVILLE ���_� G •
# ; Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` ,'�� Southold, New York 11971
MARRIAGE OFFICER ,/� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �y"'/0 , ',��� Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER ••i
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
i ermit No. 2360 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT L :;UED TO:
Name : PECONIC CESSPOOL
Address 1 PO BCX 972
City St MATTITUCK NY 11952
Rescripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.NG.
APPLICATJN APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, B,.!ILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of C: Amer PIKE, ROBERT
Mailing Ac,' cress 1 1:i8 OSTRANDER AVENUE
City St 2.E i IVERHEAD NY 11901
Property .«dress 1 14355 MAIN ROAD
C,ty c t TC . ; TTS ITUCK NY 11952
Tax Map t, ,,. section 140.00 block 3 lot 26.001
Coss
3 uiiciing Humber Cross Reference:
Issue Dao 7/07/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ��_• G'y Town Hall, 53095 Main Road
TOWN CLERK y - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS qk v' Prt tSouthold, New York 11971
Fax (631) 765-6145
MARRIAGE OFFICER :O?i � ���,
RECORDS MANAGEMENT OFFICER "'/O! �a����� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER � ',,e''�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 5, 2000
Transmitted herewith is a copy of application No. 2448 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Robert Pike
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
6.—••—•.--,------z----
„.....„...-5/7
1 `I `ev
Dated
I
OFFICE OF THE TOWN CLERIC 1'�' �l 1 ULk
TOWN OF SOUTHOLD �'' �J CQ " Application No.
aji'
FU7ABETH A.NEVILLE,TOWN CLERK : G' t
P.O.BOX 1179 L ; Construction
SOUTHOLD,NEW YORK 11971
v ^_' ; Alteration
ct� �
Telephone -�,� ire'
'/ • $10.00 - Residential !�
(631) 765-1800 =-��1ow ,." $25.00 --Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 1/0-1)
APPLICANT NAME: "ge--rfne,
APPLICANT ADDRESS: �/ /3ry 972—
SEPTIC
72 -SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
,t/j2• +y,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR `ALTERATION:
• OWNER OF PROPERTY: 4-40.-/2' ,4%G A-S(z, ( 1-0/5 vi
)
OWNER MAILING ADDRESS: /3 8 aS ,
OWNER PROPERTY ADDRESS: /9. 3 5S , s,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section I Block 3 Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
._.
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