HomeMy WebLinkAboutSmith (2) r. off, L 4'OFFO -
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ELIZABETH A.NEVILLE ��� 'y ; Town Hall, 53095 Main Road
TOWN CLERK ; - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
r �` Southold, New York 11971
MARRIAGE OFFICER �����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER
��®�i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ������ southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2785 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner SMITH, DAVE
Mailing Address 1 PO BOX 773
City St Zip MATTITUCK NY 11952
Property Address 1 1010 BAY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 143.00 block 3 lot 17.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 4/04/02 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �ti�� 'y� Town Hall, 53095 Main Road
TOWN CLERK k o - % P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS k uso® �� Fax(631) 765-6145
MARRIAGE OFFICER :� �,iL �1
RECORDS MANAGEMENT OFFICER �__"'/Ql +9'...
'iii Telephone-(631) 765-1800
FREEDOM OF INFORMATION OFFICER �� southoldtown.northfork.net
F.:1 -:-;,. 1 y 1 Ti1j R, V
rp =, ° OFFICE OF THE TOWN CLERK 9
(i; ivIAR 2 1 2002 •s TOWN OF SOUTHOLD
LG•Tow::_'•.'`_..SCUtfib • • I,n Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 21, 2002
Transmitted herewith is a copy of application No. 2886 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Dave Smith
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: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
7,7,4,,,,AVG .Z .:
Signature
0 3 �- Af2----
Dated
OFFICE OF THE TOWN CLERK /'1 ��� ( POA'
TOWN OF SOUTHOLD ,,,����CJ CQVT. Application No. V ("ELIZABETH A.NEVILLE,TOWN CLERKP.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 =v • rn
Alteration
Telephone 0,V ' �Q ,'4 $10.•00 - Residential P/
(63t) 765-1800 � �,��' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
• . APPLICATION --
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE ' 3/9'047
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
t/i/ vee.-71, nA•e-trietil
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
OWNER OF PROPERTY: ,7M' S/7,/A
OWNER MAILING ADDRESS: 1i 773
OWNER PROPERTY ADDRESS:
/Z,V0 7 /g //Vt.-
TELEPHONE
-eveTELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /1/3 Block 5 Lot / 7
CROSS, STREET: /7141,61:., /Z4
BUILDING PERMIT NUMBER CROSS REFERENCE:
hi/ ./r/
Signature of A• cant
RECEIVED BY:
Town Clerk's Office
DATE:
_____ DAVE SMITH
1010 BAY AVENUE
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