HomeMy WebLinkAboutWilliams (7) JUDITH T. TERRY :' ,x Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
> Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER /o ��� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER •I
FREEDOM OF INFORMATION OFFICER + �rr„.l
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1152 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITON OF NEW TYPE CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, ETC.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner WILLIAMS, JEFFREY
Mailing Address 1 P. O. BOX 463
City St Zip SOUTHOLD NY 11971
Property Address 1 1445 BAY AVENUE
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 9 lot 7.003
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 6/24/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
SO y
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JUDITH T. TERRY - Town Hall, 53095 Main Road
TOWN CLERK z ® rrT, P.O. Box 1179
6' ,• Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER •®�. ®�'�.4, Fax (516)(516)765-1823
RECORDS MANAGEMENT OFFICER =__'y®/ `A'r Telephone 765-1801
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FREEDOM OF INFORMATION OFFICER +",...A.v��irr
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 16, 1994
Transmitted herewith is a copy of application No. A 1195 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Jeffrey Williams .
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 offic-.. d ,_ .,
Thank you. _ / ,g94
-
Linda J. Cooper $` a DE. �}q�®_._
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - l� ,NATIONINSPECTION
DISAPPROVE - REQUIRED
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COMMENTS: -� / 4'
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JUN �t Signature
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Date 7 Y
OFFICE OF THE TOWN CLERK ,,,'",,,"''--
Town of Southold
Judith T. Terry,
Town Clerk PQ "` (a% Application No. // 3
Town Hall, 53095c 'Man Road �' • L= Conten
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P. O. Box 1179
c=1 -,-. .
Southold, New York 11971 cJ� .- �� Alteration
;`Oh �� �� $10.00 - Residential
Telephone 1 y�
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(516) 765-1801 =��� * s' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ // I �j
DATE J(i(/I� Il,1 / 7'f
APPLICANT NAME: i j'
APPLICANT ADDRESS: ieJ1,,i , — 97z
SEPTIC CESSPOOL"
DESS ! IPT ON • F PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: � &de"a.,�,"�
OWNER MAILING ADDRESS: 439 .*3
OWNER PROPERTY ADDRESS: // S'" ' / >
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section . / Block 9 Lot 7/ 3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Appli -.nt
RECEIVED BY:/6'/
4"'''(--e
Town Clerk's Office
DATE: 6/��ff�
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