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Home My WebLink AboutWamback, Elizabeth of AOFFOLit • ELIZABETH A.NEVILLE °O y��` Town Hall, 53095 Main Road TOWN CLERK p - P.O. Box 1179 coaZ % Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Ay �! '�� Fax (516) 765-1823 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER *_ / Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER • �� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2195 R Residential 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 11952 Descripton of Proposed Construction or Alteration ADDITION OF OVERFLOW TO EXISTING SYSTEM. APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner WAMBACK, ELIZABETH Mailing Address 1 PO BOX 688 City St Zip MATTITUCK NY 11952 Property Address 1 385 CAMP MINEOLA ROAD City St Zip MATTITUCK NY 11952 Tax Map No. section 123.00 block 5 lot 18.000 Cross Street Building Permit Number Cross Reference: Issue Date: 12/13/99 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) • ,ieS�FFO(�0 ELIZABETH A.NEVILLE Town Hall, 53095 Main Road ��'Z'� GyJ► � TOWN CLERK c : P.O. Box 1179 y Southold, New York 11971 REGISTRAR OF VITAL STATISTICS t' MARRIAGE OFFICER p yC Fax(516) 765-6145 RECORDS MANAGEMENT OFFICER `.4* aO�,,�� Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER . ' o'° OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office DATED: November 26, 1999 Transmitted herewith is a copy of application No. 2283-A for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Wamback 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. Signatu Ji' / 9 Date OFFICE OF THE TOWN CLERK ,t''�J V OLir�Q TOWN OF SOUTHOLD k;' G Application No I g3 FI J7ABETH A.NEVILLE,TOWN CLERK ` ��,,,, P.O.BOX 1179 Construction !/ SOUTHOLD,NEW YORK 11971 Alteration Telephone V0 �Q��' $10.00 - Residential '- - 44 (516) 765-1801 = el '� $25.00 -Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT-- RECEIVED APPLICATION NOV 2 6 1999 for uaurhoicl Town Clerk CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE 43/3 APPLICANT NAME: i)..r..//r2i,e- APPLICANT ADDRESS: eD, Z e)914/21Ye_ZZei-e../4 SEPTIC CESSPOOL i/ DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERA ION: OWNER OF PROPERTY: EZ7dact,r4/ OWNER MAILING ADDRESS: OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section /23 Block 3 Lot /e CRQ cTDEET: BUILDING PERMIT NUMBER CROSS REFERENCE: 7 Signature of .plicant RECEIVED BY: Town Clerk's Office DATE: Il(gGh 7 1 t r t ">7 Y111 a8i V iyi t 6t3-55r1757 .t3-5SP ly Wflm ►314-c1-1