HomeMy WebLinkAboutDereeder ELIZABETH A. NEVILLE /• 4 , Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
eta
REGISTRAR OF VITAL STATISTICS % Southold, New York 11971
MARRIAGE OFFICER �� s�i �� Fax (631) 765-6145
4StRECORDS MANAGEMENT OFFICER �__ 01 ib,„0� Telephone (631) 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. 2503 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL INC
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner DEREEDER, JOHN
Mailing Address 1 PO BOX 1322
City St Zip MATTITUCK NY 11952
Property Address 1 240 NORTH RILEY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 122.00 block 3 lot 37.000
Cross Street EAST LEGION
Building Permit Number Cross Reference:
Issue Date: 2/06/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
.6T
® C IJV' l/
ELISABETH A.NEVILLE `fid• Town Hall, 53095 Main Road
TOWN CLERK ; 2 P.O. Box 1179
e41 n1 i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® , 0
MARRIAGE OFFICER �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �, ®,! 46 ,s0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ils
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 26, 2001
Transmitted herewith is a copy of application No. 2591 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for DeReeder
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE 1/7
DISAPPROVE
Comments:
Signature
to
Dated
. •
OFFICE OF THE TOWN CLERK ,i•'C AF 1 UUr
TOWN OF SOUTHOLD ,.•'Qc'J �'QG Application Noa501
ELIZABETH A.NEVIL.E,TOWN CLERK 0
P.O.BOX 1179 ;4 ; Construction
SOUTHOLD,NEW YORK 11971 • t
Fr; � Alteration
Tele hone ,� 4i,r, $10.00 - Residential"
pItt
(631) 765-1800 ��1' $25.00 -Non-Residential
,...,,,'
TOWN OF,SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
' DATE d-2.. Z� p
APPLICANT NAME: Q i� ;/ /
APPLICANT ADDRESS: 6' , �
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: TCA. J
OWNER MAILING ADDRESS: P 4
OWNER PROPERTY ADDRESS: 2_Lf0 7L
.'�►� ,�,��_ - ' I I G S
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ZZ Block 3F Lot 3-7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Q
Signature of Ap Iicant
RECEIVED BY:
Town Clerk's Office
DATE:
114/1-•11
f f k
\41
- _
s- *1) it
kry t
ITO
tW,
/ „Ai
i
ify v-
7,11
'/
John DeReeder
240 North Riley Avenue
I'vlattituc'k
•