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SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4373-R Residential X Non-Residential
Fee $ 10.00 New Existing X
Name Of Owner BEHRINGER, MICHAEL
Mailing Address 1 25 CAT ROCK RD
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Mailing Address 2
City St zip COS COB CT 06807-0000
Property Address 1 1755 SHORE ROAD
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Property Address 2
City St zip GREENPORT NY 11944-0000
Owner Telephone No. 203-869-0143
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Tax Map No. section 47.00 block 2 lot 3.001
Cross Street SILVERMERE ROAD
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Issue Date: 5/07/08 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
Che
-'ELIZABETH A.NEVILLE o 095 Main Road
TOWN CLERK C* ox 1179REGISTRAR,OF VITAL STATISTICS Ow York 11971
MARRIAGE OFFICER �� ) 765-6145
RECORDS MANAGEMENT OFFICER �! � 631) 765-1800
FREEDOM OF INFORMATION OFFICER .northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10t—or Non-Residential @ $25 Application No.
Permit No.
Owner Name
Owner Mailing Address � 5 CA i PL)(-K- -zb
6nn C 1 06�
Owner Property Address �� j j S kv-o"e- ",C'&�8
Owner Telephone No. —c L� p I M.3 A 12 -75 13 l`Z- x
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 submi c y of survey with SCHD approval.)
�/ -�'\ � �\qh
Signatur Appli � Date
Received by: of an
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GL IB A.NSVT ILL C Town Hall,53M Noin ROVA
70"CLEC P.O.Box 1179
RMISTRAR OF VITAL STATISTICS Southold,New Ym*11971
MARRIAGE OFFICER Fax(631)765-6145
REC01W MANAGZMENT OFFICER Telephone(681) 765-1800
FIREEOOM OF INFORMATION OFFICER southoldtown.nq►rthfork.net
OF'F'ICE OF THE Z"O'iM CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3613 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN HOCKER
Address 1: LATHAM SAND & GRAVEL
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
-REPLACE SEPTIC TANK AND CESSPOOLS TO SUFFOLK COUNTY HEALTH SERVICE
SPECIFICATIONS
-MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,BUILINGS,PROPERTY
LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner MICHAEL BEHRINGER
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Mailing Address 1 25 CAT ROCK RD
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City St Zip COS COB CT 6807
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Property Address 1 1755 SHORE DRIVE
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City St Zip GREENPORT NY 11944
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Tax Map No. section 47.00 block 2 lot 3.100
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Cross Street SILVERMERE ROAD
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Building Permit Number Cross Reference:
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Issue Date: 1/09/08 %lizabethiA. Neville
-------- Southold Town Clerk
(TOWN SEAL)
4iLATHAM
SAND & GRAVEL, INC.
35180 Route 48•P.O.Box 608•Peconic,NY 11958
Office(631)734-6800•FAX(631)734-2318
February 8, 2008
Mr. Michael Behringer
25 Cat Rock Road
Cos Cob, CT 06807
Dear Mr. Behringer:
Thank you for your recent payment. Enclosed you will find the application for the Town
Of Southold Operation Permit and drawing that they require. It is up to you how you
handle this. Thank you for letting Latham Sand& Gravel Inc. be of service to you.
Should you need anything in the future,please do not hesitate to call.
Yours Truly,
� "
John Hocker, V.P.
JDL:rc
Marine Construction•Dredging•Precast Cesspools 9 Gravel•Fill•Topsoil•Excavating and Land Development