HomeMy WebLinkAboutDavid, Mildred aIle OFF014,
ELIZABETH A. NEVILLE $�`l`O Gym 1 Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
Southold New York 11971
REGISTRAR OF VITAL STATISTICS ;
rrt
MARRIAGE OFFICER Fax (516) 765-6145
RECORDS MANAGEMENT OFFICERfO aO�',�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER c '� 4181.
�... 00°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2169 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P.O. 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 DAVID, M I LDRED (MRS.)
Mailing Address 1 369 EASTWOOD ROAD
City St Zip WOODMERE NY 11598
Property Address 1 3825 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 131 .00 block 1 lot 3.001
Cross Street
Building Permit Number Cross Reference:
Issue Date: 10/25/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ill OfFOti-60
ELIZABETH A. NEVILLE $=`1` . ; Town Hall, 53095 Main Road
1 TOWN CLERK c P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v� t
MARRIAGE OFFICER t.
O *- Fax(516) 765-6145
RECORDS MANAGEMENT OFFICERfo atoN. � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER : ! **,s0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 6, 1999
Transmitted herewith is a copy of application No. 2257 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Mrs. Mildred David
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 - t/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
ignatu 4
to/4/ 9
Date
oFFic>E OF THE TOWN CLERK ,� (ZTOWN OF SOUTHOLD '� Application No.
Ft 17ASETH A NEVIL.E,TOWN CLERK •*
PO BOX lI74
SOUTHOLD,NEW YORK 11971 T ;
to: $10.00 - Residential
Telephone -A6 �b
(516) 765-1801 1 l ,/ $25.00 - Non Residential —
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER D1SPO� AL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
1
SEPTIC TANK or CESSPOOL f
I
Permit No.
Fee `?
DATE �� �
APPLICANT NAME:
APPLICANT ADDRESS: qq
/r /
SEPTtCCESSPOOL
_
DESCRIPTION OF PROPOSED CONSTRUCTION OP ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERAT►J�1: :
OWNER OF PROPERTY . /1/�1
OWNER MAILING ADDRESS: 3�
OWNER PROPERTY ADDRESS: - J'8 g
____._________ _ _._ % c-
TELEPHONE NUMBER OF CONTACT PERSON: 0W-91 r
TAX MAP NO. : Section /3/ Block / Lot -Fe/
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature o Applicant
RECEIVED BY:
Town Ierk's Office
DATE:
eV,
4/
e(r.s1„0
31V
ir*P
eV/
1117114/
44%
6774/orre-A, /114/b---
\\
1\1> 1Z IP NI lb'