HomeMy WebLinkAboutBuckner ELIZABETH A. NEVILLE tie ��: Town Hall 53095 Main Road
TOWN CLERK ; czt _s L P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,i ,�,fi,' �� Southold, New York 11971
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MARRIAGE OFFICER ®� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER = ®� lei Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2477 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
REPLACE EXISTING CESSPOOL WITH NEW TYPE CESSPOOL.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner BUCKNER, DANIEL
Mailing Address 1 PO BOX 145
City St Zip LAUREL NY 11948
Property Address 1 2650 BRAY AVENUE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 10 lot 7.003
Cross Street PECONCI BAY BLVD
Building Permit Number Cross Reference:
Issue Date: 12/04/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ��� '��: Town Hall, 53095 Main Road
TOWN CLERK ; $ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER � sfit .0 Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER s___-404, 4:,,��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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. 2565 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Buckner
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:
dir
gnature
(L (1,010 c.)
Dated
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OFFICE OF THE TOWN CLERK , .'�vFfUCk�►I� _, r��/' c
TOWN OF SOUTHOLD �' Q ' Application No.&€COV
ELIZABETH A.NEVILLE,TOWN CLERK �. y1
P.O.BOX 1179T ; Construction
SOUTHOLD,NEW YORK 11971 ; o • rn
Alteration
Telephone I'V' • �4 ,ri $10.00 - Residential -
(631) 765-1800 ����,����
• $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION • RECEIVED
for
CONSTRUCTION or ALTERATION PERMIT NOV 3 0 2000
SEPTIC TANK or CESSPOOL Southold Town Clerk
Permit No. .
Fee •$ , . /'///2:7/617)DATE '///2:7/617)APPLICANT NAME: /
APPLICANT ADDRESS: "fil 5
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:
OWNER MAILING ADDRESS: / Ad,
a //414
OWNER PROPERTY ADDRESS: ‘ ASO 6441
TELEPHONE NUMBER OF CONTACT- PERSON:
TAX MAP NO. : Section &C., Block is Lot 73
•
CROSS STREET: 44._
BUILDING PERMIT NUMBER CROSS REFERENCE:
0,6.//7
Signature of pp icant
•
RECEIVED BY:
Town Clerk's Office
DATE: •
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