HomeMy WebLinkAboutChabot, David OFFO400
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS CP.7.
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MARRIAGE OFFICER Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ` �ol ��� ,{,i✓ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER * lj
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1957 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 Cf Owner CHABOT, DAVID J.
Mailing Address 1 1015 SIGSBEE ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 1015 SIGSBEE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 143.00 block 2 lot 17.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 10/19/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
�o
040 6-49
A.NEVILLEt'4.k yam►; Town Hall, 53095 Main Road
TOWN CLERK ; p P.O. Box 1179
y 2Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER �- y oo Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER Ol -0,0°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: Peconic Cesspool
Transmitted herewith is a copy of application No. 2033 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for David J. Chabot
•
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
Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the folio ing recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
ignatu e
/4 ( qiY
Date
OFFICE OF THE TOWN CLERK ,'!'CAVO i'i
T(IWN OF SOUTHOLD �••• Application No.v'�0
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 _
Alteration \/
tit, $10.00 -Residential (/
•
Telephone �j,�jo �� '' •
(516) 765-1801 = 1
� '' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE /04(/
APPLICANT NAME: /3���.� ,
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
i
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION��I1OR ALTERATION:
�✓
OWNER OF PROPERTY: ,4 1 ;,) zr CA 6D
OWNER MAILING ADDRESS: lois S; s b B-w- I
M17,)
OWNER PROPERTY ADDRESS: `"--
TELEPHONE NUMBER OF CONTACT PERSON: '7.f tSi/
TAX MAP NO. : Section cif -3 Block 2—
Lot 17
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of APP Ii n
RECEIVED
RECEIVED BY:
Town Cl%r 's _.0S
DATE:
Southold Town Clerk
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