HomeMy WebLinkAboutSepenoski, John iii
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ELIZABETH A.NEVILLE '�`Z` y Town Hall, 53095 Main Road
•
TOWN CLERK c :4 P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t
MARRIAGE OFFICER •
Fax Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER ‘4* ,aoN- Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER �'�I �a'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2185 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
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 SEPENOSKI, JOHN
Mailing Address 1 37430 ROUTE 48
PO BOX 120
City St Zip PECONIC NY 11958
Property Address 1 37430 ROUTE 48
City St Zip PECONIC NY 11958
Tax Map No. section 69.00 block 4 lot 9.001
Cross Street ACKERLY POND LANE
Building Permit Number Cross Reference:
Issue Date: 11/05/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE • `Z G
TOWN CLERK < Town Hall, 53095 Main Road
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS W 11.7 Southold, New York 11971
MARRIAGE OFFICER . t Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER = 1 41 `�►,e'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 3, 1999
Transmitted herewith is a copy of application No. 2274 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for John Sepenoski
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.
Signatur
Date ( ��r7
OFFICE �'�OF THE TOWN CLERK s''� `{ t'n.
TOWN OF SOUTHOLD `1 /[ W Application No.o17� 7
- ELIZABETH A.NEVILLE,TOWN CLERK �0
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 Construction
• tt� • Alteration
Telephone 0 ir $10.00 - Residential
(516) 765-1801 =: �l 4' , '� $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
APPLICANT NAME:
APPLICANT ADDRESS: 27
. 7 A,5
SEPTIC CESSPOOL
DESCRIPTION O�//ROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: -5 'A 20-A ,
OWNER MAILING ADDRESS: ����d �T yff
P' 7 /2v
OWNER PROPERTY ADDRESS: geezemLe
J
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 09 Block Lot l -
CROSS STREET: SQceZ /
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: /
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