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HomeMy WebLinkAboutclausen to' OW,l"c. FFOL j 59 • ELIZABETH A. NEVILLE ;'_ * Town Hall, 53095 Main Road TOWN CLERK o - ik P.O. Box 1179 H Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS r MARRIAGE OFFICER ` ,f,L Fax Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER "'/Q ao Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ,9 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. 3019 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 CLAUSEN, GUSTIVE Mailing Address 1 PO BOX 308 City St Zip CUTCHOGUE NY 11935 Property Address 1 5595 PEQUASH AVENUE City St zip CUTCHOGUE NY 11935 Tax Map No. section 110.00 block 6 lot 1.000 Cross Street GLENWOOD Building Permit Number Cross Reference: Issue Date: 4/17/03 Elizabeth A. Neville Southold Town clerk (TOWN SEAL) sufFour 30 ELIZABETH A.NEVILLE �0 4 Gy� Town Hall, 53095 Main Road TOWN CLERK % o - P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Af i Southold,New York 11971 $MARRIAGE OFFICER ` `F Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER - �=°y4 jgg .401,' Telephone(631) 765-1800 FREEDOM-OF INFORMATION OFFICER ,�'� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD r • TO: Southold Town Building Department MAR 2 6 2003 FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: March 26, 2003 Transmitted herewith is a copy of application No. 3142 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Gustiv Clausen 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. Si ature 03 16A3 Dated OFFICE OF THE TOWN CLERK • , #��1 ure TOWN OF SOUTHOLD .=a Application No.,// 2 ELIZABETH A.NEVILLE,TOWN CLERK P.O.BOX 1179 ( : • ;L Construction• SOUTHOLD,NEW YORK 11971 =v rn �,. Alteration Telephone ,yg, �Q�P� $10.00 - Residential (631) 765-1800 _ l' 11 • �� gg1 f III �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 03/- Voi3 • APPLICANT NAME: PECONIC CESSPOOL APPLICANT ADDRESS: P. 0. BOX 972 MATTITUCK, NEW YORK 11952' 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: ez4v S-A/ • OWNER: MAILING ADDRESS: ss- � (f , a-U7`r✓X- o U� 6v !f OWNER PROPERTY ADDRESS: P,G , t cly of C uc.k0 o€ t'1 119x5 TELEPHONE NUMBER OF CONTACT PERSON: TAX MAP NO. : Section/`©:0-U Block 06700 Lot •004 Grz'6 GROSS STREET: G/Y-r—of ,, BUILDING PERMIT NUMBER CJROSS REFERENCE: • iete'f'"44:0� • / Signature of Applicant ila RECEIVED ,I3YGIVA r' •" n erk's Office DATE: • .c\ er-v re-it :t o 0771; { 4 . (cif ____________ JJJ (t Y4/ t Gustave Clausen 5595 Pequash Avenue Cutchogue 1