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HomeMy WebLinkAboutHelgesen • watt - JUDITH T.TERRY ® Town Hall,53095 Main Road %TOWN CLERK t g $ P.O.Box 1179 e� % Southold,New York 11971 REGISTRAR OF VITAL STATISTICS ®� �I Fax(516)765-1823 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER :�®4 `�s2Ls', C� lil� Telephone(516)765-1800 . 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. 1322 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 AN OVERFLOW TO AN EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner HELGESEN, JOHN Mailing Address 1 205 SUMMIT DRIVE City St Zip SOUTHOLD NY 11971 Property Address 1 205 SUMMIT DRIVE City St Zip SOUTHOLD NY 11971 Tax Map No. section 79.00 block 6 lot 16.000 Cross Street VICTORIA DRIVE Building Permit Number Cross Reference: Issue Date: 4/28/95 Judith T. Terry Southold Town Clerk (TOWN SEAL) ....,. ( 3 ;-_(g-- ,_ _.„ ,_ "e%, ' 4,1' ar.n„,1® ' 1 P �3 JUDITH T. TERRY t}-,:=� '7� ' ' Town Hall, 53095 Main Road TOWN CLERK = �{ 1-.,Y.'1,10,11, rin EZ N P.O. Box 1179 w\ *r ,� Southold, New York 11971 REGISTRAR OF VITAL STATISTICS " w, ` �,! Fax (516) 765-1823 MARRIAGE OFFICER Y m�'� .'n..1, 1`" �� �. Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER __ ®� �' 0. A� FREEDOM OF INFORMATION OFFICER ..//i/ii?�'� '` / pe OFFICE OF THE TOWN CLERK „ 711\e, ./..--), ., TOWN OF SOUTHOLD / -42/ 1pXTO: Southold Town Building Department `'`�t�,� �,� /,,,t,„.‘,,, � „ �8' Jia FROM: Linda Cooper, Southold Town Clerk's Office pe' q:9'X, 100 �,�' ') DATED: April 26, 1995 �' r/>-06\k/,,,%--';'', ,,, „ v tk / Transmitted herewith is a copy of application No. 1371 for an ALTERATION PERMIT for a cesspool or septic system submitted by Peconic Cesspool for John Helgesen 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 following recommendation: APPROVE - DISAPPROVE - COMMENTS: Maintain required setbacks from adjacent wells, buildings, property lines and water bodies. EXCAVATION INSPECTION REQUIRED. Signatur- _ � o q3------ Da 3_®Da - OFFICE 'OF THE TOWN CLERK """" Town of Southold s''alaVal./ `'0 Judith T. Terry, Application No. 737/ Town Clerk �' �® l/�'• pP Town Hall, 53095 Main Road Construction e� P. U:' Box 1179 'c Alteration Southold, New York 11971 Telephone 0,� 406 0° $10.00 - Residential C/ (516) 765-1801 �ol '� ' � ' $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 ,1/2,6h5 APPLICANT NAME: , APPLICANT ADDRESS: 7 / /./M� SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTR CTION OR ALTERATION: OWNER OF PROPERTY: 1 /. " I i e OWNER MAILING ADDRESS: -i' �Lc� � .7 , . OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section 7f. Block Lot CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: Signatur/. pplicant RECEIVED BY: o n 1eerk's Office DATE: 0./.° 4 3o2y/ i,-/ •-''''. .' 1 i •' . ., e •,.., '''. — - .. •_ ,,-_ , Z Wirt A(, ma.............t.,.. ../ -1- ICI_ , 1 ,, ael..: 46,--, e_yea.1000tlirsalciBasazarm...,• Nos.., N A I 1 cv 190 t4' , . 1 1 ! 1 , 1 kirVeatt . , r , r . , , I — OW D E g-N r it , ft' .. . ,