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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 ---------------------------- ----- ------------------------ City St Zip RESTON VA 20194 -------------------- -- ---------- Property Address 1 3205 WESTPHALIA ROAD ------------------------------ ---- ------------------------- City St Zip MATTITUCK NY 11952 -------------------- ------------ Tax Map No. section 113.00 block 13 lot 22.000 Cross Street DEER DRIVE ------------------------------ Building Permit Number Cross Reference: Issue Date: 5/25/99 ---------------------------------- Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) F 01( • ELIZABETH A. NEVILLE TOWN CLERK 0 coo REGISTRAR OF VITAL STATISTICS 1O MARRIAGE OFFICER • NAGEMENT OFFICER FREEDOM OF RECORDS INFORMATION OFFICER y��� 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 e ala �o� bo , o� l Cara+-hwokl C� j,�r_S71-)h41ia /`d