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Home My WebLink AboutJP Modular Homes I v c� SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4439-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner J P MODULAR HOMES INC ------------------------------ Mailing Address 1 131 HICKS STREET ------------------------------ Mailing Address 2 14otnn-6 ------------------------------ City St Zip BROOKLYN NY 11201-0000 ol-2- -------------------- -- ---------- Property Address 1 5805 MAIN BAYVIEW ROAD ------------------------------ Property Address 2 ------------------------------ City St Zip SOUTHOLD INY 11971-0000 -------------------- -- ---------- Owner Telephone No. 718-624-0386 ------------ Tax Map No. section 78.00 block 7 lot 5.006 ------ --- ------ Cross Street SMITH DRIVE SOUTH ------------------------------ ---------------------------------- Issue Date: 7/24/12 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) o�osuFFot��o ELIZABETH A.NEVILLEC� Gy� Town Hall, 53095 Main Road TOWN CLERK C4 P.O.Box 1179 REGISTRAR OF VITAL STATISTICS O _ -_Southold,New York 11971 Fax 31) 5-6145 RECORMARRIAGE S MANAGEMENT OFFICER y��• ��0�� ,Tel phone-(631 765-1800 - 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 No - e ldenhal @$25 Application No.:H Permit No. 3 Owner Name &0 I /U . Owner Mailing Address D Owner Property Address 5 '3(3-5' MAW 8AUtFEW •° , - " Owner Telephone No. g `y G 03 Tax Map No: Section 7 , b Block '7 Lot 7 r 0 0 l� .Cross Street � r — C)U 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.) Si a of Applicant date _ Received by: pF SOUTyoI ELIZABETH A.NEVILLE,RMC,CMC '` O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS CIO Southold, New York 11971 :rd ® �Q Fax(631) 765-6145 MARRIAGE OFFICER 22 Tele hone (631) 765-1800 RECORDS MANAGEMENT OFFICER l�/ P FREEDOM OF INFORMATION OFFICER �oU01 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD October 18, 2010 J. P. Modular Homes Inc. - 131-Hicks-Street - Brooklyn,NY 11201 RE: 1000-78.-7-5.6 Dear Madame/Sir: Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars ($10.00) for,a residential system and twenty-five dollars ($25.00) for a non- residential system. Your check should be made payable to the "Southold Town Clerk". An application form is enclosed. Please complete the requested information and return the application, proper fee, and LOCATION MAP (map must indicate the location of the cesspools)/septic tank(s), giving approximate distances in feet from any buildings to the pools and distances between the pools. Should you have any questions concerning this matter, please do not hesitate to contact this office. Very truly yours, Carol Hydell Account Clerk Enclosures o��OF SOUI��I ELIZABETH A.NEVILLE,RMC, CMC O Town Hall, 53095 Main Road TOWN CLERK [ bS P.O. Box 1179 REGISTRAR OF VITAL STATISTICS C*") Southold, New York 11971 ' �r G MARRIAGE OFFICER Fax(631) 765-6145 � ® �o RECORDS MANAGEMENT OFFICER �l'i Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER cOUNV I southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3984 R Residential'X Non-Residential Fee $ 10.00` Septic X Cesspool PERMIT ISSUED TO: Name : J P MODULAR HOMES INC. Address 1: 131 HICKS STREET City St zip BROOKLYN NY 11201 Descripton of Proposed Construction or Alteration , SANITARy ,SYSTEM FOR SINGLE FAMILY DWELLING. , APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. REF #R10-07-0114. FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT. Name Of Owner MARK BAXTER ------------------------------ Mailing Address 1 131 HICKS STREET ------------------------------ ------------------------------ City St zip BROOKLYN NY 11201 ----------=--------- -- ---------- Property Address 1 5805 MAIN BAYVIEW ROAD -------------------- ------------------------------ City St zip SOUTHOLD NY 11971 -------------------- -- ---------- Tax Map No. section 78.00 block 7 lot 5.006 Cross Street SMITH DRIVE SOUTH ------------------------------ Building Permit Number Cross Reference: 3 Issue Date. 10/18/10 5zabethTA eville -------- Southold Town Clerk (TOWN SEAL)