HomeMy WebLinkAboutCombs, Michael ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road
TOWN CLERK d P.O. Box 1179
CA Southold,New York 11971
REGISTRAR OF VITAL STATISTICS IS Fax(631)765-6145
MARRIAGE OFFICER Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER www.soutlioldtownny.gov
FREEDOM OF INFORMATION OFFICER
FFICE OFT E TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Lynda Rudder, Southold Town Clerk's Office
DATED: December 19, 2016
Transmitted herewith is a copy of application No. 4452 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Michael Combs
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
Dated
� 19�Ji..�3�!a9 etvvorrs aumrrm•®.w.�
P.O.Box 1179
TOWN CL-mm Souzhokl,Now York 11971
RSGISi.AR or�G CS (631)76.10 -ISM
MABICAGE OMS T e(6SI)'76690t�
UWAGENSK-T OIFFT= �orttfare�,
T7 CLERK
' .s" OID
TOWN OF CATER DWMCT
A. C.A-
OPERAW
CF
C TANK
fl V or -RendmtmI@S25_ Application No.Non
NO.
ApplioMt MzMA9 Address 0. SOX . 497
IGW,yORK 11949
Septic T :- .---Pr 0=900i Onstruction or
•$fief w OaOf PrON
CCS
Locadon Ofproposod Om-stuOd
l
®
Ow=Of S -
A
tzoI
6� c
d phonen
Tax I%GV O:
cross
AppLICATION. NEWS
NoTg
e LO
UJ
�J
N
* * * RECEIPT * * *
Date: 12/19/16 Receipt#: 214893
Quantity Transactions Reference Subtotal
1 Septic Permit- Construct- Resid. 4452 $10.00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CASH $10.00 Peconic, Cesspool
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Peconic, Cesspool
P O Box 487
Laurel, NY 11948
Clerk ID: LYNDAR Internal ID:4452