HomeMy WebLinkAboutMajeski, Lillian . /4'
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,.ELIZABETH A. NEVILLE � /....
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ELIZABETH A. NEVILLE �� : Town Hall, 53095 Main Road
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TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS $ Southold, New York 11971
MARRIAGE OFFICER � y ���,1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_ O' �a�,,lTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,,,o
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 21, 2000
Transmitted herewith is a copy of application No. 2500 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Lillian Majeski
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.
ignature
C11-( (66
Dated
1111
OFFICE OF THE TOWN CLERK
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TONOFSOUTHOLD �''� J. • Application No.
ELIZABETH A.NEVILLE,TOWN CLERK i .
P.O.BOX 1179 ;_ .2C
; Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone b." �Q�'1 $10.00 -Residential (/
(631) 765-1800 -= 1 y,,." $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 91 2-v OQ
APPLICANT NAME:
APPLICANT ADDRESS:-• Q / '72,
(moi
SEPTIC CESSPOOL ci
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 3,.-d
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OWNER PROPERTY ADDRESS: .3 Z v a 2�
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TELEPHONE NUMBER OF
CONTACT PERSON:
TAX MAP NO. : Section IM Block Lot
CROSS STREET: /Y /
BUILDING PERMIT NUMBER CROSS REFERENCE:
"(s41'
Signature of plicant
RECEIVED BY:
q. Town Clerk's 0 •
DATE: l/
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Town Of Southold
P.O Box 1179 �I
Southold, NY 11971 ,I
* * * RECEIPT * * *
Date: 09/21/00 Receipt#: 5063
Transaction(s): Subtotal
1 Septic Permit-Construct- Resid. $10.00
Check#: 5063 Total Paid: $10.00
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Name: Peconic, Cesspool
P 0 Box 972
Mattituck, N Y 11952
Clerk ID: HELENEH Internal ID: 18143