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Home My WebLink AboutHamilton 1 T.ArBR'18 A.NBVZiri.Eao�S�(/ly0 Town Hall,53095 Main Road To"CUM P.O.Boa 1179 REGISTRAR OF VI'T'AL STATISTICS � � Southold,New York 11971 WAARL409 OFFICER Fax(631) 765-6145 RECORDS MANAOBDdENT OFFICER Telephone(631.) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4376-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner HAMILTON, JEREMY ------------------------------ Mailing Address 1 1535 PARK AVENUE ------------------------------ Mailing Address 2 ------------------------------ City St Zip MATTITUCK NY 11952-0000 -------------------- -- ---------- Property Address 1 1535 PARK AVENUE ------------------------------ Property Address 2 ------------------------------ City St Zip MATTITUCK NY 11952-0000 -------------------- -- ---------- Owner Telephone No. 631-298-4435 ------------ Tax Map No. section 123.00 block 2 lot 3.001 ------ --- ------ Cross Street MARRATOOKA ROAD ---------------------------------- Issue Date: 9/23/08 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) ELIZABETH A.NEVILLE �`�`` G� Town Hall, 53095 Main Road TO"CLERK C5 � P.O. Box 1179 y Z Southold, New York 11971 REGISTRAR OF VITAL STATISTICS v MARRIAGE OFFICER Oy,. Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERTelephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER O'� 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. q3 7� Permit No. 3 5 0 Owner Name F PV Owner Mailing Address ! 3 /Of 4? Owner Property Address t ( Owner Telephone No. & Tax Map No: Section ( L 3 Block 2— Lot 3 ' Cross Street Mor�"0 0 4 ki- Please check each that applies: New Construction ✓ Alteration to Exlsti 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.) i Siyiature of Applicant Date Received by: ARTCO DRAINAGE CORP. P.O. BOX 1132 MATTITUCK, NEW YORK 11952 (631) 298-9660 - FAX (631) 298-2291 Certificate of sewage dispose system by installer Health Dept Reference number R10-06- 0103 Suffolk tax map#: Dist:1000 Sect(s) 123 Blk(s) 2 Lot(s)31 Project name or Address: Subdivision Name&Lot# Applicant's Name Jeremy Hamilton Description of system installed: Septic Tank Volume (gallons) 1000 Shape Rectangle Name of Precast manufacturer: Coastal Pipeline Leaching Pools Number of pools 1 Diameter and depth 8' x 12' Name of Precast manufacturer: Coastal Pipeline Other Attach or sketch below the measurements from building corners to the access covers of disposal system. sT 4 b y I GP 3� 5 I GL,P dos-r I hereby certify that the subsurface sewage disposal system, described herein,has been installed by me in accordance with the plans and standards of the Suffolk County Department of Heath Services: and is operational. Installer F_ Signature Date Artco Drainage Corp 63Y-298-9660 Consumer Affairs License Number 206LW pf SO�ryo ELIZABETH A.14EVILLE ,�� Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER ��o , 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. 3510 R - Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : AGNIESZKA DROZDOWSKA Address 1: PO BOX 93 City St Zip MATTITUCK NY 11952 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING 1ST FLOOR ADDITION OF NEW 2ND FLOOR-ATTACHED ONE CAR GARAGE FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT Name Of Owner JEREMY & LAUREN HAMILTON ------------------------------ Mailing Address 1 1535 PARK AVENUE ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Property Address 1 SAME ------------------------------ ------------------------------ City St Zip 0000 -------------------- -- ---------- Tax Map No. section 123.00 block 2 lot 3.100 Cross Street MARRATOOKA ROAD ------------------------------ Building Permit Number Cross Reference: 2 " ---------- --------- Issue Date: 3/15/07 Elizabeth A. Neville ------ Southold Town Clerk (TOWN SEAL) Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 08/22/08 Receipt#: 27994 Transaction(s): Reference Subtotal 1 1 Septic Permit-Operation - Resid. 4376 $10.00 Check#: 1869 Total Paid: $10.00 Name: Hamilton, Jeremy 1535 Park Avenue Mattituck, NY 11952 Clerk ID: LINDAC Internal ID:4376