HomeMy WebLinkAboutVandenburgh, Richard 0,��OFFOL,i- "-
ELIZABETH A.NEVILLE .�4 Town Hall, 53095 Main Road
TOWN CLERK P.O.c _ P.O. Box 1179
t ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICSrrr'I Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER
MARRIAGEOFFICER Z t • • Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICERJi[ 4'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2053 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 VANDENBURGH, RICHARD
Mailing Address 1 1405 OAK DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 1405 OAK DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 80.00 block 1 lot 40.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 4/16/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK
Town of Southold , Utirce= Application No. ��
Judith T. Terry, Town Clerk I 4
Town Hall, 53095 Main Road .4. . Construction_
P. 0. Box 1179 Alteration
Southold, New York 11971
Tele hone = ,r 4110%--'_ ��' $10.00 - Residential
p ��1 * , ,a $25.00 - Non-Residential
(516) 765-1801
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for �1 le
CONSTRUCT ION or ALTERAT I,: N PERMIT � '
SEPTIC TANK or CESSF130L
Permit No.
Fee $
DATE .i /•
APPLICANT NAME: _.__ -
APPLICANT ADDRESS: &G/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION _—
LOCATION MAP: Must be attached hereto before; permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR A _TERATION: 1//9N"ff Q-4-GY19v
OWNER OF PROPERTY : - � a ��/�./a.-4 ' -
OWNER MAILING ADDRESS: 19'05 dam /,1Z
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ,--Block (_ Lot `Z
C140-5-5-STREET :
BUILDING PERMIT NUMBER CROSS REFERE;' CE:
RECEPiella
Signature of A plicant
RECEIVED BY : APR 1 2 1999
Town clerk's Office
DATE:
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