HomeMy WebLinkAboutRaynis, Donald igS�FF0
ELIZABETH A.NEVILLE y goy Town Hall, 53095 Main Road
TOWN CLERK c P.O. Box 1179
ti Southold, New York 11971
REGISTRAR OF VITAL STATISTICS =O Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER A Tele hone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ���.1 * 'i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1956 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 RAYNIS, DONALD AND KATHLEEN
Mailing Address 1 1750 SMITH ROAD
City St Zip PECONIC NY 11958
Property Address 1 1750 SMITH ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 98.00 block 3 lot 20.000
Cross Street INDIAN NECK LANE
Building Permit Number Cross Reference:
Issue Date: 10/19/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
,_'//I
��/if OF F04•
ELIZAETH A.NEVILLE .Z� 9
B *<��j Town Hall, 53095 Main Road
TOWN CLERK �1 0 ,1 P.O. Box 1179
ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � �y-
MARRIAGE OFFICER Fax (516) 765-1823
�� � Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER RI li •si , P
•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 13, 1998
Transmitted herewith is a copy of application No. 2032 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Cesspool for Donald & Kathleen Raynis
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following ree6mmendations:
APPROVE '7
DISAPRROVE
Comments:
ignature
tt
Dated
OFFICE OF THE TOWN CLERK �"' Wir�Q
TOWNOFSOU BOLD Application No, G32
Fi.i7ABETH A.NEVILLE,TOWN CLERK LZO
P.O.BOX 1179 �_ Construction-- _
SOUTHOLD,NEW YORK 11971 G T
Alteration
Telephone ,j► �Q�'i� $10.00 - Residential
(516) 765-1801 �1 1 �,,i' $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 4074 if it
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APPLICANT NAME: faK/rit.f.----C--
APPLICANT
ADDRESS: oT• (/ 9 2.-
SEPTIC
iSEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
WArA) 17)-aidieffrti
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTER ' TION:
OWNER OF PROPERTY: A e .40iA
OWNER MAILING ADDRESS: /752) A.Aie
ilJ�'uZ /VE
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:QQ
TAX MAP NO. : Section %S? Block Lot a a
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Ap cant
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RECEIVED BY: c, /l,/ L/ � ._,Lk0
o n Clerk's Office
DATE: 70 y,P'
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