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HomeMy WebLinkAboutBrown, Clement FO4Co ELIZABETH A.NEVILLE Town Hall, 53095 Main Road TOWN CLERK c P.O. Box 1179 REGISTRAR OF VITAL STATISTICS y , Southold, New York 11971 MARRIAGE OFFICER 0 * Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER t 0� I Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER -�C1 4s , ' ,, OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1991 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 REPLACE CAVED IN CESSPOOL WITH NEW TYPE. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner BROWN, CLEMENT Mailing Address 1 345 KNOLLWOOD ROAD City St Zip MATTITUCK NY 11952 Property Address 1 345 KNOLLWOOD ROAD City St Zip MATTITUCK NY 11952 Tax Map No. section 107.00 block 6 lot 10.000 Cross Street GRAND AVENUE Building Permit Number Cross Reference: Issue Date: 1/22/99 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) or OFFO(A, OG, ELIZABETH A.NEVILLE $ y‘ Town Hall, 53095 Main Road TOWN CLERK ; < P.O. Box 1179 t ti Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICSFax (516) 765-1823 MARRIAGE OFFICER y ���� Telephone(516) 765-1800 RECORDS MANAGEMENT OFFICER ` 1 P FREEDOM OF INFORMATION OFFICER �0( Alp *toile bye'' or/�i OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office DATED: January 13, 1999 Transmitted herewith is a copy of application No. 2071 for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Clement Brown 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 followin recommendation: APPROVE - DISAPPROVE - COMMENTS: Maintain required setbacks from adjacent wells, buildings, property lines and water bodies. EXCAVATION INSPECTION REQUIRED. ignatu Date • , „ OFFICE OF THE TOWN CLERK ',!'C��,��f Ure' TOWN OF SOUTHOLD ��� Application No. FI J7ABETH A.NEVILLE,TOWN CLERK P.O.BOX 1179 Construction SOUTHOLD,NEW YORK 11971 ; 0 T Alteration Telephone 4490/ �O�',' $10.00 -Residential (516) 765-1801 ' Air ,," $25.00 -Non-Residential >,o TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE 42�./ 9/ APPLICANT NAME: � C� APPLICANT ADDRESS: P"rt' /1972- SEPTIC 7Z-SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 4 /moi /. LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: /r, iG—vt 44/e61-74, - OWNER MAILING ADDRESS: OWNER PROPERTY ADDRESS: -• •- TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section /07 Block e, Lot j 2 CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: ‘"(Z /#/tig(%.' Signature of Apant RECEIVED BY: Town Clerk's Office DATE: Y . S 'Si , /(A/dAe/(iald-I v E f C0,17 , b I I 1 b Yt 1\MAr2' f&® . p(9l 4 C 6 I ci • 11-1 tt, r, pool_ -- ..____ 61) '.1CIP.i D© 3