HomeMy WebLinkAboutKelemen •
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SUFFO`,'
ELIZABETH A.NEVILLE %/j* Town Hall, 53095 Main Road
TOWN CLERK % o - % P.O. Box 1179
2
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %gir
MARRIAGE OFFICER `% Fax�� �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;-'/®1 #0®0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
OFFICETTOF THE
SOUTHOLD WAOSATEppSLD
POSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2931 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 KELEMEN, STEPHEN
Mailing Address 1 PO BOX 811
City St Zip ORIENT NY 11957
Property Address 1 77 MAIN ROAD
City St Zip ORIENT NY 11948
Tax Map No. section 15.00 block 2 lot 17.004
Cross Street
Building Permit Number Cross Reference:
Issue Date: 10/03/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
oSEfO�,�� q7 l„ ma®
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ELIZABETH A.NEVILLE Il °a` Town Hall, 53095 Main Road
TOWN CLERK % o - P.O. Box 1179
ti
REGISTRAR,OF VITAL STATISTICS % t
Southold New York 11971
MARRIAGE OFFICER `: ,jiL � �1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;_ ®1 jig #ao,i” Telephone (631) 765-1800
FREEDOM OF INFORMATIONFI
OFCR - ���� southoldtown.northfork.net
', t i i.11 _.,.a a
2002 :jOFFICE OF THE TOWN CLERK
, � ! TOWN OF SOUTHOLD
TO: ITYSoizthold-Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 25, 2002
Transmitted herewith is a copy of application No. 3051 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Kelemen
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.
,4_,..)
Signature
/6)/i 5'/72.-
Dated
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OFFICE OF THE TOWN CLERK ��OLk44
TOW? OF SOUTHOLD d Q.=
� Application No. 305
ELIZABETH A.NEVILLE,TOWN CLERK ,• O _I
P.O.BOX 1179 . ; Construction 4,/
SOUTHOLD,NEW YORK 11971 rn •
=3 Alteration
Telephone
WOO
(631)
$10.00 - Residential
63t 765-1800 _ �l
( ) $25.00 - Non-Residential
0.01110
TOWN OF SOUTHOLD
• SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
OCT 2 5 2002
SEPTIC TANK or CESSPOOL Southold Town Clerk
Permit No.
Fee .$ „
DATE lbl1 1.—
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952 '
SEPTIC , CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ,ALTERATION
0-1)-00.1fet,"1-.)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: I1 k E L -, e1tj
OWNER MAILING ADDRESS : PO B.6/ 3 � I
R. I g N'T'
OWNER PROPERTY ADDRESS: 77 fy+1/,�� " �, 1 /�'p�
O1Zi �V ! a / / /SI
TELEPHONE NUMBER OF CONTACT PERSON: (fig--16 53
TAX MAP NO. : Sectioii I S Block .' Lot Iii 9
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of piicant
RECEIVED BY:
Town CTerk's Office
DATE:
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Stephen Kelemen
77 Main Road
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