HomeMy WebLinkAboutCampbell ELIZABETH A.NEVILLE /j� * Town Hall, 53095 Main Road
TOWN CLERK d - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
MARRIAGE OFFICER ` 1i Fax, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � ®1 �_,W Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,s'� 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. 3026 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 CAMPBELL, BRUCE & MAUREEN
Mailing Address 1 620 MEDAY AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 620 MEDAY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 100 lot 14.001
Cross Street COX NECK ROAD
Building Permit Number cross Reference:
Issue Date: 5/14/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE ��h`Z` Gy Town Hall, 53095 Main Road
TOWN CLERK p ; P.O. Box 1179
ti Southold New York 11971
REGISTRAR OF VITAL STATISTICS Vg)
1,� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER =y�f ® i��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
APR 2. 2. 2003 TOWN OF SOUTHOLD
'-TO:-' Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
r'
DATED: April 21, 2003
Transmitted herewith is a copy of application No. 3150 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Bruce &Maureen Campbell
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.
* * * * * * * * * * * *
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.
Signature
` .j-043
Dated
OFFICE OF THE TOWN CLERK ,i" INN OUC
TOWN OF SOUTHOLD �'� COG= �Application No.�
ELIZABETH A.NBVILLB,TOWN CLERK
44
Clet
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971
v � Alteration
Telephone 0' Qyi�,,, ' 00.00 -Residential 1�
(631) 765-1800 '40.t 44 �,,�'�0 $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION _ .
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /5/63
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ;ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952 '
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION,�. //////IOR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• . OWNER OF PROPERTY: /3, rC r, /z/q•eoL•eeh / / e//
OWNER MAILING ADDRESS: d€!® eddy a-v-e
/yI `Tvc.k
OWNER PROPERTY ADDRESS: "r7,7
TELEPHONE NUMBER OF CONTACT PERSON: (,9 -96 5g
TAX MAP NO. : Section /13 Block ki Lot' / , /
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CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
?"41-e-1„ Signature of 'ip`iceplicant
RECEIVEDBY:
Town Clerk's Office
DATE:
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BRUCE & MAUREEN CAMPBELL
620 MEDAY AVENUE
MATTITUCK
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