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Home My WebLink AboutDebruin o- -- {A ,iciii //,®��gd1FF0�,�ee ELIZABETH A.NEVILLE ;_ #� Town Hall,53095 Main Road TOWN CLERK o P.O.Box 1179 Z Southold,New York 11971 REGISTRAR OF VITAL STATISTICS '► MARRIAGE OFFICER 0 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER `#4. 0v a® ///, 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. 30600 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, BUILDING, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. - Name Of Owner DE BRUIN, WILLIAM Mailing Address 1 24 EAST BAYVIEW AVE City St Zip MASSAPEQUA NY 11758 Property Address 1 2570 PINE TREE ROAD City St Zip CUTCHOGUE NY 11935 Tax Map No. section 104.00 block 2 lot 13.000 Cross Street BAY AVENUE Building Permit Number Cross Reference: Issue Date: 7/29/03 Elizabeth A. Neville Southold Town Clerk (TowN SEAL) I ®SVFFOUr ELIZABETH A.NEVILLE ;01-0'� oG# Town Hall, 53095 Main Road TOWN CLERK o P.O. Box 1179 y Southold, New York 11971 REGISTRAR OF VITAL STATISTICS r MARRIAGE OFFICER y ' ��, Fax(631) 765 6145 RECORDS MANAGEMENT OFFICER we" 4010 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. 30600 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, BUILDING, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name of Owner WILLIAM DE BRUIN Mailing Address 1 24 EAST BAYVIEW AVE City St Zip MASSAPEQUA NY 11758 Property Address 1 2570 PINE TREE ROAD City St Zip CUTCHOGUE NY 11935 Tax Map No. section 1.04 block 2 lot 13 Cross Street BAY AVENUE Building Permit Number Cross Reference: Issue Date: 7/29/03 Elizabeth A. Neville Southold Town clerk (TOWN SEAL) r 30130 `} %guFFOL�c ELIZABETH A.NEVILLE i : TOWN ti� # > Town Hall, 53095 Main Road TOWN CLERK % oP.O.Box 1179 % y Z , Southold,New York 11971 REGISTRAR.OF VITAL STATISTICS v' MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER "'OQl �a�iii Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER ------..0'', ,�, ��I,." southoldtown.northfork.net ii l - - - -- ----71 -,l 1 OFFICE OF THE TOWN CLERK 1 1.4 ;' TOWN OF SOUTHOLD JUN 2 4 2003 E -' E �' t 1E_Jo,•• r Southold-Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: June 24, 2003 Transmitted herewith is a copy of application No. 3187 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for De Bruis • 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 1/ DISAPPROVE Comments: Maintain required setbacks from adjacent wells, buildings,property_lines and water Bodies. EXCAVATION INSPECTION REQUIRED. . 91"e....,‘:, Signature 6//1"- /A, Dated II �rrrrrr.r,,� ',' . OFFICE OF THE TOWN CLERK � c��F�OLkc TOWN OF SOUTHOLD ��; �Gy-i Application No. 'J(� ELIZABETH A.NEVILLE,TOWN CLERK P.O.BOX 1179 ,� Construction SOUTHOLD,NEW YORK 11971 v rn 1 Alteration Telephone ,j- Ar��'',':, '$10.:00 - Residential (631) 765-1800 = "1' �,,.'�� $25.00 - Non-Residential , TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT RECEIVED APPLICATION • JUN 21 2,003 for CONSTRUCTION or ALTERATION PERMIT Southold Town Clerk SEPTIC TANK or CESSPOOL Permit No. • ' Fee '$ DATE /9� APPLICANT NAME: PECONIC CESSPOOL APPLICANT ADDRESS: P. O. BOX 972 MATTITUCK, NEW YORK 11952 ' SEPTIC CESSPOOL A-- DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 0-eee- 5;12_-e, LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERAATION:1 OWNER OF PROPERTY: ,k),��1 -7a,,. .C/,Q!i✓�Q� �, OWNER MAILING ADDRESS: ir:=24 cc.c, ,fe/i! //7' OWNER PROPERTY ADDRESS: ®PC 7d Z ee - a4Cteltev C7 n TELEPHONE NUMBER OF CONTACT PERSON: 49,,•"94.37 TAX MAP NO. : Section /0 41 Block Lot /3 CROSS STREET: ezp_g_c BUILDING PERMIT NUMBER CROSS REFERENCE: yezt;46 ' 1 I Signatureof Ap icant RECEIVED BY Town Clerk's Office DATE: • 3i' 00 4, avito ()Dig 1.. WILLIAM DE BRUIN 2570 PINE TREE ROAD CUTCHOGUE