HomeMy WebLinkAboutEssig ELIZABETH A.NEVILLE,1btMC may® l/,y Town Hall,53095 Main Road
TOWN CLERK - P.O.Box 1179
C = Southold,New York 11971
REGISTRAR OF VITAL STATISTICS O . Fax(631)765-6145
MARRIAGE OFFICERt'
RECORDS MANAGEMENT OFFICER �,� � Telephone(631)765-1800
www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF OWN OI�E TOWN p
LD
AUG 1 1 2017
O: Southold Town Building Department BUILDWG DEPT.TOWN OF SOIT HOLD
ROM: Sabrina Born, Southold Town Clerk's Office
)ATED: August 11, 2017
ransmitted herewith is a copy of application No. 4506 for a Cesspool/Septic Tank ALTERATION
ermit submitted by:
Peconic Cesspool for Kathryn Essist
'lease review the application and location map; advise if the project has received Suffolk County Healtl
)epartment approval and if this office may issue the permit.
lease complete the form below and return it to me. Thank you.
have reviewed the application and location map of the project cited above and make the following
-commendations:
APPROVE
DISAPPROVE
:omments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
REC'EEIVED
2Y���l
AUG 17 2017 Signature
Southold Town Clerk
ffol't
ELIZABETH Aa NEVILLE,MMIC Town Hall,53095 Main Road
TOWN CLERK P.O. Box 1179
CA Southold,New York 11971
REGISTRAR OF VITAL STATISTICS %9 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
'O: Southold Town Building Department
ROM: Sabrina Born, Southold Town Clerk's Office
)ATED: August 11, 2017
ransmitted herewith is a copy of application No. 4506 for a Cesspool/Septic Tank ALTERATION
ermit submitted by:
Peconic Cesspool for Kathryn EsA14
lease review the application and location map; advise if the project has received Suffolk County Healt]
)epartment approval and if this office may issue the permit.
lease complete the form below and return it to me. Thank you.
have reviewed the application and location map of the project cited above and make the following
-commendations:
APPROVE
DISAPPROVE
'omments: Maintain required setbacks from adjacent wells buildings property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED _
Signature
®��gufFOt�-c
ELIZABETH A. NEVILLE �,°Z` ®G� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
C4 Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER ® ® `Z' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICERTele hone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �o'� �� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRICTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10–i/— or Non-Residential @ $25 Application No. �)Q�Q
Permit No.
Applicant Name PECONIC CESSPOOL,
ru BU" 401
Applicant Mailing Address
Septic Tank or Cesspool
Brief Description of Prop ed Con
structio or ration
Location of Proposed Construction/Alt )ation:
Owner of Property:
Owner Mailing Address: 301 Lyuu
n —I
Owner Property Address: AV
. �
Name and phone number of contact person�7 9
Tax Map No: Section / Block Lot
Cross Street
NOTE: LOCATION MAY MUST RE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S YTH H TH DEP NT P, OVAL
Slgnaturf licant
Qe _µ - -
Date
Received by:
Lie
cw
1
* * * RECEIPT * * *
Date: 08/11/17 Receipt#: 227345
Quantity Transactions Reference Subtotal
1 Septic Permit-Construct- Resid. 4506 $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: SABRINA Internal ID:4506