HomeMy WebLinkAboutRaynor 4 _ , 4 viii
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ELIZABETH A. NEVILLE '4%7Y' `` Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� y` � �1�,Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = ®1 `. *," Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER •''''a
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2478 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
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 RAYNOR, FRANK & BERTHA
Mailing Address 1 PO BOX 707
City St Zip MATTITUCK NY 11952
Property Address 1 3376 WICKHAM AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 107.00 block 9 lot 15.000
Cross Street CONKLIN ROAD
Building Permit Number Cross Reference:
Issue Date: 12/04/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
• 4.
111
•. _a* i°1 OF FOLt aLni(
ELIZABETH A. NEVILLE �� e : Town Hall, 53095 Main Road
TOWN CLERK c P.O. Box 1179
REGISTRAR OF VITAL STATISTICS00 Pr? Southold, New York 11971
MARRIAGE OFFICER : 4 . . r_% Southold,
Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �® ®aI Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,, ss
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 28, 2000
Transmitted herewith is a copy of application No. 2566 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Raynor
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
DISAPPROVE
Comments:
Signature
111)d/00
Dated
OFFICE OFTHETOWN CLERK ;'� cIfrOCk� Application No.
��
TOWN OF SOUTHOLD ,'% G7
ELIZABETH A,NEVILLE,TOWN CLERK � Construction
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 p rn ; Alteration
CP �•`
4:2004, $10.00 - Residential _z
(6311 _
G3)Telepho1800 ne = �1' �f[��,� I $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$
DATE niZtArd
APPLICANT NAME:
APPLICANT ADDRESS: /,/ /A 2�
•
SEPTIC CESSPOOL-I-'-
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/
i
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: IA4 .�y
*7o--�
OWNER MAILING ADDRESS: :; e,,
OWNER PROPERTY ADDRESS: 3-37
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /v 7 Block 9 Lot /5—
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Kpplicant
RECEIVED BY:
Town Clerk's Office
DATE:
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