HomeMy WebLinkAboutStepnowsky ELIZABETH A. NEVILLE, MMC ®® ��
Town Hall,53095 Main Road
TOWN CLERK �� y� P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 ® Fax(631)765-6145
MARRIAGE OFFICER e� �� 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: November 28, 2017
Transmitted herewith is a copy of application No. 4544 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Stepnowsky
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:
Signature
Dated
* * * RECEIPT * * *
Date: 11/28/17 Receipt#: 229802
Quantity Transactions Reference Subtotal
1 Septic Permit- Construct- Resid. 4544 $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 4544
ELIZABETH A.NEVILLE �G Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS a y Southold, New York 11971
MARRIAGE OFFICER • Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ®'� j 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.
Permit No.
Applicant Name
PECONIC CESSPOOL
Applicant Mailing Address
LAUREL NY 119408
Septic Tank or Cesspool
Brief Descri ti i If sed o tructi 4t ration
Location of Proposed Constrac ' n/Alter n: �I Eno Jl�
Owner of Properly:
Owner Mailing Address:
Owner Property Address: c
1?
1
Name and phone number of contact person �% %2 � 3/�✓�bZ—Cl" /
Tax Map No: Section Block Lot Z)
Cross Street M U 1n M�
NOTE: LOCATION MAP MUST BE SUBMI ED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WIT ALTH PART NT APPROVAL
Si cNApplicant Date
Received by:
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Installment#4 by 12/15/17 58
We appreciate this opportunity to serve you. If you have any questions,please contact us.
Sincerely,
GRZEGORZ GUGALA, CPA