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Home My WebLink AboutHammond ii i i i ELIZABETH A.NEVILLE,MMC ��® �y Town Hall,53095 Main Road ' TOWN CLERK P.O.Box 1179 y Southold,New York 11971 REGISTRAR OF VITAL STATISTICS .� Fax(631)765-6145 MARRIAGE OFFICER �'� a®`' Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER o! www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK " TOWN OF SOUTHOLD D D TO: Southold Town Building Department JUL 19 2017 FROM: Sabrina Born, Southold Town Clerk's Office BU,DING DWr. TOWN OF SOUTHOLD DATED: July 19, 2017 Transmitted herewith is a copy of application No. 4499 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Kimmarie Hammond � Please review the application and location map and advise if the project has received Suffolk County i Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Thank you I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE I� DISAPPROVE Comments: Maintain required setbacks from adjacent wells,buildings, property lines and water j Bodies. EXCAVATION INSPECTION REQUIRED. a RECEIVED ! J U L 2 5 2017 Signature I;' Southold Town Cierk Dated f F OL eel, ELIZABET14 A. NEVILLE,MMC & Town Hall,53095 Main Road TOWN CLERK P.O. Box 1179 CA Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 0-' Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS MANAGEMENT OFFICER www.southoldtownny.gov FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Sabrina Born, Southold Town Clerk's Office DATED: July 19, 2017 Transmitted herewith is a copy of application No. 4499 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Peconic Cesspool for Kimmarie Hammond 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. Thank you 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 ELIZABETH A. NEVILLE l.°L` G� Town Hall, 53095 Main Road TOWN CLERK ® P.O. Box 1179 REGISTRAR OF VITAL STATISTICS CAOD Southold, New York 11971 MARRIAGE OFFICER `� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER *A Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $10 or Non-Residential @ $25 Application No. q"7gq Permit No. PECONIC CESSPOOL Applicant Name BOX, 487 Applicant Mailing Address NY 11948 Septic Tank or Cesspool Brief Description of Prgnstructio r Alteration Location of Proposed Construction/Alteration: / L Owner of Property: jr`/Y,� C !del/ L'�'/omno/�k Owner Mailing Address: l5 �p 011" vb 11 3 Owner Property Address: Name and phone number of contact person Tax Map No: section , Bl k__ �_ Lot Cross Street NOTE: LOCATION M STVB TTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY W1 E THNT RO . 7 -V17 Signature opplc /Date Received by: f f 22 E r , * * * RECEIPT * * * Date: 07/19/17 Receipt#: 226033 Quantity Transactions Reference Subtotal 1 Septic Permit- Construct- Resid. 4499 $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 437 Laurel, NY 11943 Clerk ID: SABRINA Internal ID:4499