HomeMy WebLinkAboutGross, Mary Jane � •
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ELIZABETH A. NEVILLE $�`Z`� Gym�• Town Hall, 53095 Main Road
TOWN CLERKt
t r4 P.O. Box 1179
% Z Southold New York 11971
REGISTRAR OF VITAL STATISTICS v 1 '
/ Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER
MARRIAGE OFFICER �` 41 AN'1 Telephone (516) 765-1800
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FREEDOM OF INFORMATION OFFICER 41 * ,'
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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. 2155 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner GROSS, MARY JANE & ARTHUR
Mailing Address 1 PO BOX 812
City St Zip SOUTHOLD NY 11971
Property Address 1 275 SUN LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 76.00 block 1 lot 14.000
Cross Street BERRY LANE
Building Permit Number Cross Reference:
Issue Date: 10/01/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �� To all, 53095 Main Road
TOWN CLERK i = , f t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % �y. �,�, So o�d, New York 11971
MARRIAGE OFFICER L 11 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER Ly4� ��. /�1 TO�r BLDG.
F.DEPT.OL Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER1 * .so.
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: September 20, 1999
Transmitted herewith is a copy of application No. 2241 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic cesspool for Mary J ane and Arthur Gross .
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 following recommendation:
APPROVE - `�
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature&
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Date
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OFFICE OF Mk TOWN CLERK °...0 \�f of ( 0� 61/
TOW'SOFsoLTHOLL> % V L 4= Application NoP? `Y
IJLAl3LTHA Nh%ILIt IOwl ,;Kh ; Q
Yu BOX 11N i.t .iC. Co - ion
SOUTHOLD NI.w' JRK I •+7I : 2C
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Alteration
Telephone `0�,� �C`J(' 510.00 esldentlal
(516) 765-- 1801 Q/ * � "✓ ?;.00 Non Reslder�tla!
— •••••,' _________
TOWN OF SOUTHOLD
SOUTHOLD .'ASTE'VrATER DISPO AL DISTRICT
APPLICATION
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CGN ;;C I ION 4'4 AL.TLRAT I-iN PERVI.I
SEPTIC TANK or LESSF'OOL {
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Permit No. r
Fee ..,;
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DA t l:: ..;=;71,/j41—; /s 1pe
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:\PPLIC,ANT NAME
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,LiDRESS: '
E f.SSPOUL_
OF PROPO'_;i..C_ `
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—_-_-. ______.__ __ • I-
LOCATION MAP: Must bt- 2ttaclied hereto before ,)ermit may be. issued
LOCATION OF PROPOSED CONST RUC T IC`N OR A' i ERAT "ON
OWNER OF PROPER r Y. : Al ./ alIt/Le t 44/.4a> 1:
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OWNER MAILING AUU`•?L.S . _._____.
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OWNER PROPERTY '"
TELEPHONE NUMBER OF L JNTACT PERSON : __olf,P-7.6.S�
TAX MAP NO. : Section 7.0 Block / Lot /T
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE : _ ,___ _
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Signature of ;6plicant
RECEIVED BY : _
Town Clerk's Office —
DATE:
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