HomeMy WebLinkAboutPeyton (2) ,/�,o�OgUFFO �0G
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ELIZABETH A. NEVILLE 1,�� * Town Hall, 53095 Main Road
TOWN CLERK o % P.O. Box 1179
ti Southold, New York 11971
REGISTRAR OF VITAL STATISTICS vt
MARRIAGE OFFICER ‘1.1
��,fiL �����, Fax(631) 765 6145
RECORDS MANAGEMENT OFFICER x;_' 01 -0 .•� ii 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. 3070 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 INSPECTINO REQUIRED.
Name Of Owner PEYTON, ELIZABETH & A JUST
Mailing Address 1 PO BOX 540
City St Zip ORIENT NY 11957
Property Address 1 195 VILLAGE LANE
City St Zip ORIENT NY 11957
Tax Map No. section 18.00 block 5 lot 8.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 9/08/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
3010
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ELIZABETH A.NEVILLE ,'�0 ®4\` Town Hall, 53095 Main Road
TOWN CLERK i p P.O.Box 1179
y $ Southold New York 11971
REGISTRAR OF VITAL STATISTICS . �!f � '
MARRIAGE OFFICER :°O 0Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =4�f� *0. oil Telephone(631) 765-1800
FREEDOM OF INFORMATION:OFFICER =_'� * ,,�� southoldtown.northfork.net
\ `._--`r`1 `- , OFFICE OF THE TOWN CLERK
\',,'1 .13-Z 2 la TOWN OF SOUTHOLD
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TOO : 1( .'.Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 17, 2003
Transmitted herewith is a copy of application No. 3199 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Elizabeth Peyton &Anthong Just
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.
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Signature
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OFFICE OF THE TOWN CLERK �''r �OLk G I??
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TOWN OF SOUTHOLD '��c'J Application No.
ELIZABETH A.NEVWB,TOWN CLARK �'
P.O.BOX 1179 � Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone , oe, �®�1�'11 $10.00 - Residential
(631) 765-1800 = 1 * $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
DATE `jsS`03
APPLICANT NAME: PECONIC CESSPOOL
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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.
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LOCATION OF PROPOSED CONSTRUCTION (JR ALTERATION: ` �,e. -i
. OWNER OF PROPERTY: Ciel i c ,/- PeyT®� /9/ Ajovc- i'Sy}-
OWNER MAILING ADDRESS: ,/q ki//411" "Z/t-r/a—
OWNER PROPERTY ADDRESS: 42A.1.40--A.,74/ /4p // 757
TELEPHONE NUMBER OF CONTACT PERSON :
TAX MAP NO. : Section /e Block C25' Lot 4°"i
CROSS STREET:
BUILDING PERMIT NUMMMRrn r7ROSS REFEf EN 7:
,Iq
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RECEIVED
JUL •
Signature of Appli nt
UL ;1 7 2003
RECEIVE ' Y
Town Clerk's Office
Southold Town Clerk
DATE: .
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MAIN
/ NL IGEN I JUN VII LAI IAA I U JUrt v i h vIVLN I IUrr
!MAIN RD.OF SECTION 7209 OF NEW '.1"K STAT" DUCATION LAW.
EXCEPT AS PER SEC ION *9 - S•:•/VISI 2, ALL CERTIFICATIONS
(PL Y.S.Rte.25) HEREON ARE VALID •R THIS 'P ANP OPIES THEREOF ONLY IF
SAID MAP OR COPIES : - T/E ESS : SEAL OF THE SURVEYOR
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WHOSE SIGNATURE APPEA" HEREO
ADDITIONALLY TO COMPLY WIT' ID LA' T TERM ALTERED BY"
MUST BE USED BY ANY AND ALL 'VEYOR; UTILIZING A COPY
��0 OF ANOTHER SURVEYOR'S MAP. TER ,. SUC' AS "INSPECTED"AND
BROUGHT - TO - DATE"ARE NOT IN •P LANCE WITH THE LAW.
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SURVEY OF
PI/
/ PROPERTY
3 t eo A T ORIENT
~ 3 I ® � TOWN OF SOUTHOLD
k-q k a SUFFOLK COUNTY, N Y.
/ 1000- 18-05-08®
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1 CERTIFIED TO,
�0 (c• ELIZABETH PEYTON
a ANTHONY JUST
� aR ` FIDELITY OF NEW Y NATIONAL TITLE INSURANCE COMPANY
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PECONIC S YOBS,, t
AREA = 13,875 9.. � (6311 7b'S; ;0i1 631) 765 - 1797
P. 0. BOX+9.9LAND ,,,"
�l� 1230 TRA V�'t-ER 5`TREET
i" V SOUTHOLD, N.Y. 11971
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