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HomeMy WebLinkAboutFields, Ruth o •* - JUDITH T. TERRY ; Town Hall, 53095 Main Road TOWN CLERK : p • r= • P.O. Box 1179 tls �� Southold, New York 11971 REGISTRAR OF VITAL STATISTICS = VO ,' Fax (516) 765-1823 MARRIAGE OFFICER //���� y ,� Fax (516) 765-1801 RECORDS MANAGEMENT OFFICER '��(/1 1 �0°I FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1067 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 ADDITON OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES, AND WETLANDS. EXCAVATION INSPECTION REQUIRED. Name Of Owner FIELDS, RUTH Mailing Address 1 P. O. BOX 1617 City St Zip MATTITUCK NY 11952 Property Address 1 400 EAST LEGION AVENUE City St Zip MATTITUCK NY 11952 Tax Map No. section 143.00 block 4 lot 8.000 Cross Street BAY AVENUE Building Permit Number Cross Reference: Issue Date: 12/01/93 Judith T. Terry Southold Town Clerk (TOWN SEAL) •,,,,,o��FFOLKeoG NOV 16 JUDITH T. TERRY ; t� '� Towp Hall, 53095 Main Road TOWN CLERK : v T ""' $ P:O. BOX 1 179 REGISTRAR OF VITAL STATISTICSFax (5 �` Southold, New York 11971 MARRIAGE OFFICER V 6A,0 ��Q�,1 Telephone16)(516)5-1823 765-1801 /6 7 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office DATED: November 16, 1993 • Transmitted herewith is a copy of application No. A1100 for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for Ruth Field 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. -L7cc.Cti Linda J. Cooper * * * * * * * * * * * * * I have reviewed the application and location map of the project listed above and make the following recommendation: APPROVE 17- - EXCAVATION INSPECTMN DISAPPROVE - REQUIRED COMMENTS: '% �� G7`r'`-r GI/4 ; /21.7, _ / -17.141-7,1- G 31-e, 1,-(4.1...- 1,010 - /� i. 4111 a t Li a 4011 .74* 6r� Signat e Date OFFICE OF THE TOWN CLERK ,,,''",,,,,,,,, Town of Southold r ,'' . �FFD��COI/ Application No. // ' Judith T. Terry, Town Clerk god Town Hall, 53095 Main Road ;� Construction P. 0. Box 1179 � — M+ Southold, New York 11971 ; Alteration Telephone ��,� $10.00 - Residential (516) 765-18011 1 �;, ' $25.00 - Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICAT ION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ DATE ii / /7 /f3 APPLICANT NAME: APPLICANT ADDRESS: /04 97z- SEPTIC 7zSEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION • ("--‘7-"/ LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERAT ION: OWNER OF PROPERTY: fiet4A F�� OWNER MAILING ADDRESS: ,4 /4/7 gni A 9r-z, OWNER PROPERTY ADDRESS: 4©I (. � TELEPHONE NUMBER OF CONTACT PERSON: AO' 7�G TAX MAP NO. : Section / c/3 Block 9 Lot ` CROSS STREET : A BUILDING PERMIT NUMBER CROSS REFERENCE: 0/4/ :‘, Signature of Applic t RECEIVED BY: / 4 �u Town Clerk's Office DATE: r/C / I 111,1 11111111111111, 111,14 1,1161111.1141.1111111611111 11,1111ii ill111 111111 11 id W1111,1,11111110 1111111111111,11,1 11 111111 il,1 111,1111 111, 1 1 .11 1,11111,11 111111 1 1 i 11111 i1 1 1 J,„1 , 1,i L.,,Illim.11L....„,___41 1 i ...:6 \\ , i * ‘.............rr,-.. a....,..........-...............,-.....-...............,...............-,,..,-............ ............. . . . \ .0 --N. "----- i , , (• ....... 421'1 co-5c pa 0 15 , '1' ky• 3 . .„. (e' lyilirfr"t 115Ls‘ 47a-1-1./ 'Si el..)...g.14.1....L. .....6 • 1 1