HomeMy WebLinkAboutRobinson, Janice /o%SUFF04
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ELIZABETH A. NEVILLE ��_ ; Town Hall, 53095 Main Road
TOWN CLERK % o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % �' Southold, New York 11971
%MARRIAGE OFFICER : 1,i/� ��, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ‘4*
RECORDS �� �1� Fax
(631) 765-1800
Allig
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DI POSAL PERMIT
CONSTRUCTION OR ALTER TION PERMIT
SEPTIC TANK or CESS OOL
Permit No. 2304 R Residentia 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 11 52
Descripton of Proposed Construction or Alteration
REPLACE EXISTING CESSPOOL WITH NEW OVERFLOW
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner ROBINSON, JANICE
Mailing Address 1 PO BOX 2029
City St Zip ORIENT NY 11957
Property Address 1 CEDAR BIRCH LANE
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 8 lot 27.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 5/01/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ����_ y� Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
; y, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Q Fax(631) 765-6145
MARRIAGE OFFICER t.
RECORDS MANAGEMENT OFFICER =_�Ol �►aO�0',/ Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER _ •,���
... .•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 21 , 2000
Transmitted herewith is a copy of application No. 2392 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Janice Robinson
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the follow'ng recommendation:
APPROVE -
P
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
ignature
ati)-115
Date
• 1
OFFICE OF THE TOWN CLERK '�' O 0[KQ
TOWN OFSOUTHOLD %1•Z QG= Application No. aArl-->
FI i7ABETH A.NEVILLE,TOWN CLERK
`; Construction
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971
=v ^_' ; Alteration
vs * ,
Telephone , skier, $10.00 - Residential (/
(516) 765-1801 : 1 ,��' $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /0 .�
DATE J In)
APPLICANT NAME: °P.'14-#/212(1"
APPLICANT ADDRESS: vr,
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
�.1 .�
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION- OR A TERATION:
OWNER OF PROPERTY: �6i',LGf_c1
OWNER MAILING ADDRESS:
� f2-D29
OWNER PROPERTY ADDRESS: D/` e5- 7 1. J/ S7
TELEPHONE NUMBER OF CONTACT PERSON: v2
TAX MAP NO. : Section /S-' Block Si Lot 7-7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Ap`( ant
RECEIVED BY:
Town Clerk's Office
DATE:
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