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HomeMy WebLinkAboutHurley SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4428-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner RICHARD HURLEY ------------------------------ Mailing Address 1 8880 NASSAU POINT ROAD ------------------------------ Mailing Address 2 �� �•-��/ ------------------------------ City St Zip CUTCHOGUE NY 11935-0000 O� 4 Property Address 1 8880 NASSAU POINT ROAD ------------------------------ Property Address 2 - ------------------------------ City St Zip CUTCHOGUE NY 11935-0000 -------------------- -- ---------- Owner Telephone No. 631-734-8537 ------------ Tax Map No. section 118.00 block 6 lot 2.000 ------ --- ------ Cross Street CLEARWATER LANE ------------------------------ ---------------------------------- Issue Date: 6/08/11 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) o��pF 50(/Tyol ELIZABETH A.NEVILLE,RMC,CMC O Town Hall, 53095 Main Road TOWN CLERK l�[ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER • �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERTelephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER �coum� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Carol Hydell, Southold Town Clerk's Office DATED: June 6, 2011 Transmitted herewith is a copy of application No. 4020 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Richard Hurley 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 Carol Hydell 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 .:r o��SQFfO��►C � ®G ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road TOWN CLERK C P.O.Box 1179 REGISTRAR,OF VITAL STATISTICS O Southold, New York 11971 RECORDS Telephone Fax (631) 5 MANAGEMENT OFFICER ��®® ��0�� Tele hone(63 6 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 /,--,or Non-Residential @ $25 Application No. Permit No. - LLL-2 S Owner Name lG &,D/,g�W Owner Mailing Address s D Owner Property Address Owner Telephone No. 6) a3 Tax Map No: Section G Block (, Lot �'. L'oy Cross Street Please check each that applies: New Construction Alteration to Existing System Residential I--- Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) Signature of Applicant Date Received by: 22 a+ f �N"A t '•1 -41 ta ZZ i. ^(a � • "�� _ 1> �ter`.ham 1 I T i '` t) L _4 USAA / Pay Bills Page 2 of 2 . 4* l 4 Copyright © 2011, USAA. http s://www.usaa.com/inet/ent_multipay/BillPayPrintS ervlet?actio... 6/1/2011