HomeMy WebLinkAboutAlbrecht, Amy �••
ELIZABETH A.NEVILLE � •V1 .0 f
; Town Hall, 53095 Main Road
TOWN CLERK c 4 P.O. Box 1179
y 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER 11 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER `#4, a 'lO� /l Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER '� 4 #00�
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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. 2158 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : AMY ALBRECHT
Address 1 : 175 DEPOT LANE
City St Zip CUTCHOGUE NY 11935
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 ALBRECHT, AMY
Mailing Address 1 175 DEPOT LANE
City St Zip CUTCHOGUE NY 11935
Property Address 1 175 DEPOT LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 5 lot 25.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 10/01/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OOP
,,ile.ofF04 a , a
ELIZABETH A. NEVILLE 'A.,-
Town Hall, 53095 Main Road
TOWN CLERK c -4 P.O. Box 1179
t y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-6145
MARRIAGE OFFICER Tele hone (516) 765-1800
RECORDS MANAGEMENT OFFICER `4J �O�'1�� P
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: September 20, 1999
Transmitted herewith is a copy of application No. 2244 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Amy Albrecht
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 applica ' and location map of the project listed
above and make the fol ing recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature
9w Q9Date
OFFICE OF THE TOWN CLERKCOOLK
TOWN OF SOUTHOLD e CSG= Application
ELIZABETH A.NEVII.I.F,TOWN CLERK ,�
P.O.BOX 1179 } Construction
SOUTHOLD,NEW YORK 11971 C'it N
Alteration c_/ ___
O
Telephone ,j' �Q�i� $10.00 - Residential Q`
(516) 765-1801 ! � ," $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ q q
DATE co t
APPLICANT NAME: ktkt 1Pt-eCk�
APPLICANT ADDRESS: ] �1 11 �i3S
7 � �� �a n \ C��� q t1�P 0 I� � l-1 �
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
CSr7 qo a e •itk-
1
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: V4 \\))(-Pc
OWNER MAILING ADDRESS: i/7rT ,
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 776 73y 1 y /
TAX MAP NO. : Section /O 2., Block 7 Lot 2 5—
CROSS
CROSS STREET: / Z7,c 1& ,/-?QC
BUILDING PERMIT NUMBER CROSS REFERENCE:
,
1• ature of Applicant
RECEIVED BY:
wn Clerk' Of ' e
DATE: 7,,cj
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UNAUTHORIZED ALTERATION OR ADDITION
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' - '' '-. TO THIS SURVEY IS A VIOLATION OF
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tk. '.1' 916:i,' ( • ••••)• A ts, EDUCATION LAW.
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THE LAND SURVEYORS INKED SEAL OR
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EMBOSSED SEAL SHALL NOT BE CONSIDERED
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, e .c6_ NOTE: GUARANTEES INDICATED HEREON SHALL RUN
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IS PREPARED, AND ON HIS BEHALF TO TIC
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