HomeMy WebLinkAboutVerity (3) ,. � :
41
JUDITH T. TERRY ,lTown Hall, 53095 Main Road
TOWN CLERK T • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , tin Southold, New York 11971
•
MARRIAGE OFFICER ® �- ," Fax (516) 765-1823
Telephone (516) 765-1801
Jig
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 660 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
INSTALLATION OF ONE OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 12° MAXIMUM BETWEEN POOLS.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner VERITY, JARVIS
Mailing Address 1 30485 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 30485 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 2 lot 20.000
Cross Street STILLWATER AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/16/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
Y
® CSC p'
Town Hall, 53095 Main Road
�,. -. •, ,,..: ,��'��� P.O. Box 1179
Q.( i3O,o Southold, New York 11971
.JUDITH T. TERRY ������100 TELEPHONE
TOWN CLERK - (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD j-j ` am.
„A p`�yi`9 Pamau..
October 29, 1990 N, ' '!� 1'
9
To: Southold Town Code Enforcement 'Officer h''=; l ! 1)!
ri
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A675 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Jarvis Verity
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: oia � c,Q'L
04.41
4
�V
VeSignature
11 ` ���p
Date
. 40-
OFFICE OF THE TOWN CLERK ,r$
Town of Southold sol. \\VUL
Judith T. Terry, Town Clerk •�' KC®l/� �
Application No.
Town Hall, 53095 Main Road ;• '41 • s' Construction /✓
P. 0. Box 1179
1=3 -Southold, New York 11971 s jl . � ' Alteration
Telephone ‘V. �� �• $10.00 - Residential
(516) 765-1801 - '01 4 � o' $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 AWA i/ P
APPLICANT NAME: 1,.ele",c/7-7,---r. , l
APPLICANT ADDRESS: ,D I 7-L---
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
�. • �-'�'i mac— .
J - /
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:`
OWNER OF PROPERTY: c/ <' - //e/L-C 6
OWNER MAILING ADDRESS: d �e
I 1 Air -!T)—LAJ
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / 62 2— Block Lot D
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:,
%ihfç5Ii2
Sigur'e of Applicant
RECEIVED BY: RECORD
Town
EC DTown Clerk's Office
DATE: OCT 2 9 199U
To clerK Sol 'cold
t
-'•.s-''Ill ,. PI flp
' d .
,i,q
of
r� i ,,64 ft'-
� f
lo, (1,1:----/ ei(14), , _ I 1,./.y ‘tit) cll.'
i
-y 1
kidrti''
'
VP(11 _6r
-. lv/ fie/
- -
6 tiff-fvd < v -- l� i----