HomeMy WebLinkAboutGoldman, Robert ,,,,o��FFOIKeoo
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : = •
v T P.O. Box 1179
cls �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = /, Fax (516) 765-1823
MARRIAGE OFFICER Q �
RECORDS MANAGEMENT OFFICER =7'21 I•�r.1 Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER ,i,,,,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1187 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 WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner GOLDMAN, ROBERT T.
Mailing Address 1 930 JACKSON STREET
City St Zip NEW SUFFOLK NY 11956
Property Address 1 930 JACKSON STREET
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 6 lot 10.000
Cross Street NEW SUFFOLK ROAD
Building Permit Number Cross Reference:
Issue Date: 8/12/911 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY �,, 4 Z Town Hall, 53095 Main Road
TOWN CLERK . p T ;
P.O. Box 1179
VS *. � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO 7. 6,' Fax (516) 765-1823
MARRIAGE OFFICER '_' , �.0 .� Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER _ ,l + r�
FREEDOM OF INFORMATION OFFICER =-•..�../oviii#rrr
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD I r
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TO: Southold Town Building Department
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FROM: Linda Cooper, Southold Town Clerk's Office # _
DATED: August 10, 1994 IL TOWBLDG. DEPT.
N OF SOUTHOLD
Transmitted herewith is a copy of application No. A1233 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Robert T. Goldman ,
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 - EXCAVAINSPECTION
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OFFICE OF THE TOWN CLERK ,,,''",,,,------
Town of Southold ,i0 AFFOIIrc- =
Application No. f a-3
Judith T. Terry, Town Clerk �'Q� Gy
Town Hall, 53095 Main Road Z !� ; Construction
P. O. Box 1179 � .
Alteration 4-i
Southold, New York 11971 sus *'��
Telephone , ► Q��' $10.00 - Residential '
(516) 765-180101 1 '' $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 $ ¢
DATE O
i/Ztr/f_y_____
APPLICANT NAME: /ige...,€07,,,e„...e„ 0,...i...-94.")..-,
APPLICANT ADDRESS: /., ® /�� 972__
-
SEPTIC CESSPOOL 1--"--
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATIO
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR CTION OR ALTERA I N:
OWNER OF PROPERTY: 7'
OWNER MAILING ADDRESS: 93e ,./h ��,Q�)z
'7ia4i, S-eylig.-a 4, 72 . y //95-4
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ?ir- 9 ) .5(F."
TAX MAP NO. : Section /17 Block 6 Lot f 0
CROSS STREET: 71 ` 5:1A/1 l'Illet
BUILDING PERMIT NUMBER CROSS REFERENCE: r-
--id'&46',it I
Signature of pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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