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Home My WebLink AboutCobley SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4435-R Residential X Non-Residential Fee $ 10.00 New Existing X __ Y Name Of Owner JOHN R COBLEY IF ------------------------------ Mailing Address 1 680 MASON DRIVE °�•�'� 1d ------------------------------ Mailing Address 2 ------------------------------ City St Zip CUT CHOGUE NY 11935-0000 -------------------- -- ---------- ,0 Property Address 1 680 MASON DRIVE ------------------------------ Property Address 2 i ------------------------------ City St Zip CUTCHOGUE NY 11935-0000 -------------------- -- ---------- Owner Telephone No. 631-734-2264- Tax Map No. section 104.00 block 7 lot 3.000 ------ --- ------ Cross Street HAYWATERS ------------------------------ ---------------------------------- Issue Date: 2/27/12 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) I ®SUFFot�' � G ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road TOWN CLERK cz P.O. Box 1179 REGISTRAR OF VITAL STATISTICSO Southold, New York 11971 Fax(631) RECORDS MANAGEMENT OFFICER �RIAGE OFFICER ��1 ��o�� TeleP hone (63 657654 800 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. Owner Name GO p Owner Mailing-Address Masai Q L Owner Property Address e Owner Telephone No. l D� Tax Map No: Section Block Lot Cross Street Please check each that applies: New Construction Alteration to Existing System Residential�—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.) Signa e o ppl�ant Date Received by: i` \Q�a tig� c��r�,L ELIZABETH A.NEVILLE,MMC Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS a� Fax(631)765-6145 MARRIAGE OFFICER Telephone(631)765-1800 RECORDS OF MANAGEMENT OFFICER southoldtown.northfork.net FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOuiriOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 4003 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JOHN R CORBLEY Address 1: 680 MASON DRIVE City St Zip CUTCHOGUE NY 11935 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner JOHN R CORBLEY ------------------------------ Mailing Address 1 680 MASON DRIVE ------------------------------ ------------------------------ City St Zip CUTCHOGUE NY 11935 -------------------- -- ---------- Property Address 1 680 MASON DRIVE ------------------------------ ------------------------------ City St Zip CUTCHOGUE NY 11935 -------------------- -- ---------- Tax Map No. section 104.00 block 7 lot 3.000 Cross Street HAYWATERS DRIVE ------------------------------ Building Permit Number Cross Reference: , %*214 Q -------------------•', Issue Date: 2/03/12 -Eli-zabeth--A. Neville -------- Southold Town Clerk (TOWN SEAL)