HomeMy WebLinkAboutPrellwitz �%4FFO[�►
ELIZABETH A.NEVILLE,MMC O C�jy Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
Cie Southold,New York 11971
REGISTRAR OF VITAL STATISTICS • Fax(631)765-6145
MARRIAGE OFFICER ,fi �� Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER ��l �`1 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: January 5, 2018
Transmitted herewith is a copy of application No. 4555 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Latham Sand & Gravel,Inc. for Wendy Prellwitz
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
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.
RECEIVED
Signature
FEB - 6 2018 ®Z
Dated
Southold Town Clerk
ELIZABETH A.NEVILLE, MMC v'` .�'v" Town Hall, 53095 Main Road
TOWN CLERK A' ' ` -,�'` _ PO. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS '"`- Fax(631) 765-6145
MARRIAGE OFFICER :`= `"' . ' Telephone(631) 765-1800
RECORDS MANAGEMENT OFFICER www.souiholdtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK OR CESSPOOL
Permit No. 4555 X Residential _ Non-Residential
Fee$ 10.00 _ Septic Cesspool
PERMIT ISSUED TO:
Name: LATHAM SAND&GRAVEL, INC.
Address: P.O. BOX 608
City St Zip: PECONIC NY 11958
Description 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: WENDY PRELLWITZ
Mailing Address: 3'/:WENDELL ST
City St Zip: CAMBRIGE MA 02138
Property Address: 7134 INDIAN NECK LN
City Sf Zip: PECONIC NT 1 11958
Tax Map No. Section 86.00 Block 07.06 Lot 07.01
Cross Street Wood Ln
Building.Permit Number Cross Reference:
Issue Date: 04/09/18 (,(.
Elizabeth A. Neville
Southold Town Clerk
A.NE'PIIAE Town Hall,55095 Main Road
TOWN CIJ= ® P.O.Box 1179
RECEN AR OF VrrAL STA=MCS Southold,New York 11971
MARRIAGE OFFICER ® Fax(631)765-6145
RECORDS OFFICES Telephone(631)765-1800
FREDDOM OF INFORMATION OFFICER - 1 southoldtown.northfork.net
OFFICE OF TIMM Cg.
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION-
CON S'1`YtU4'T'YON or Ai:T+A ATION mmm,
CESSPOOL or SEPTIC TANK
Residential @$I qZ or Non-Residential $25 Application No.
—�^j Permit No. .
Applicant Name�1)()n
Applicant Mglmg Address
�
Septic Tank— or Cesspool X
Brief Descn' tion Of Pro osed Construction or Alteration��lpoz .S `Qr it ,�-� --.j,W� �-1ZQ9A Ila n
AnL. - ti x LgoXI ncq.Q. J6, Su{poll_
Coun4-Ly Wa14h SQ'-L/ice5 5 -. ri.c�Fwns.
Location of Proposed Con s�ucdon/Alteration:
Owner of Property-
Owner
roperty Owner Mailing Address::3%'5zL/Cp- 111 -.
Owner Property Address--.2-134 Ind ma n :neck- La
Name and phone number of contact person :Yotnn .f->oCp�
Tax Map No: ADDU Section Block-- 2. Lot
Cross Street Wig 19 h 2aaH,
NOTE: LOCATION MAP MUST BE SUBMITTED VVIm .APP]L][CATI®N:. NEW
CONSTRUCTION,,REQUIRES SURVEY TIVgAPPROVAL- O
- 18
Si :. a _..of Applicant Date
Received by.
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