HomeMy WebLinkAboutGrathwohl, Jim` ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-6145
Telephone (516) 765-1800
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2071 R Residential X Non -Residential
Fee $ 10.00 Septic X Cesspool
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 POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner GRATHWOHL, JIM
Mailing Address 1 11690 STUCK BRIDGE LANE
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City St Zip RESTON VA 20194
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Property Address 1 3205 WESTPHALIA ROAD
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City St Zip MATTITUCK NY 11952
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Tax Map No. section 113.00 block 13 lot 22.000
Cross Street DEER DRIVE
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Building Permit Number Cross Reference:
Issue Date: 5/25/99
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Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
F 01(
• ELIZABETH A. NEVILLE
TOWN CLERK
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REGISTRAR OF VITAL STATISTICS 1O
MARRIAGE OFFICER •
NAGEMENT OFFICER
FREEDOM OF RECORDS INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 11, 1999
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
Transmitted herewith is a copy of application No. 2157 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Jim Grathwohl
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.
o-Ye--'�
Linda J. Cooper
I have reviewed the application and location map of the project listed
above and make the followir}g recommendation:
APPROVE
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
S' nature
Date
` OFnCE OF THE TOWN CLERK
TOWN OF SOUTHOLD
fMABETH A. NEVILLE, TOWN CLERK
P.O. BOX 1179
SOUTHOLD, NEW YORK 11971
Telephone
(516) 765-1801
Permit No. c007
Fee $
,V®'��FFOtK�D�i
TOWN OF SOUTHOLD
Application No,,?/J 7
Construction
Alteration
$10.00 -Residential Z/
$25.00 -Non-Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICANT NAME:
APPLICANT ADDRE
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
DATE SA/ A
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:—
OWNER MAILING ADDRESS: 1&7t) S�(J-t��y ��� ,t,..�
;9e, ! /4 P,3
OWNER PROPERTY ADDRESS: 31o!;7-
TELEPHONE
1o!;7-TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section 1/3 Block /3 Lot 2 '2 --
CROSS
CROSS STREET : _ 2.2)r- �)r__ fy1c._)JQ;.i UCC_
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of pplicant
RECEIVED BY: 9004 -W
T s Office
DATE
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