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Home My WebLink AboutZimmerman * "SOF 5�1/r ELIZASSTH A.NEVHAZ,RISC,CMC `"" Town Hall,53095 Main Road `!O"Clj= , P.Q. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ,r Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER , southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOLTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4392-R Residential X Non-Residential Fee $ 10.00 New Existing X Name Of Owner TOM ZIMMERMAN ------------------------------ Mailing Address 1 16 CANTABERRY ROAD ------------------------------ Mailing Address 2 APT 2I ------------------------------ City St Zip GREAT NECK NY 11021-0000 Property Address 1 265 SALT LAKE LANE ------------------------------ Property Address 2 ------------------------------ City St Zip MATTITUCK NY 11952-0000 Owner Telephone No. 516-903-1539 ------------ Tax Map No. section 144.00 block 4 lot 9.000 Cross Street BAY AVENUE ------------------------------ ---------------------------------- Issue Date: 4/01/09 Elizabeth A. Neville ------ Southold Town Clerk (TOWN SEAL) o�oSUFFot,��o ELIZABETH A.NEVILLE Ca Town Hall, 53095 Main Road TOWN CLERK CA = P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O Southold, New York 11971 MARRIAGE OFFICER y�• a�� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 1 �► Telephone(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 V or Non-Residential @$25 Application N Permit No. �L Owner Name Owner Mailing Address �o e 0CI- \C>-e_c-'C�\ Owner Property Address oZLoS S(a 1 O�ku L j2) Owner Telephone No. rJ� -q c)3- \S 3c;k - W\\ - C, n c.a): � Tax Map No: Section y Block Lot Cross Street ?_ &4 ��e 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.) C \ O ignature of Applicant Date Received by: Coastline Cesspool &Drain Service 4225 Bridge Lane Cutchogue, LI,-NY 11935 (631-734-6585 V h , � a° e;; n�� SCCA Lic. No. 134-W DEC No. 1A-600 o��pF SOl/Tyol� ELIZABETH A. NEVILLE,RMC, CMC O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER • i0 Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERl Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �COU NOV, southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHCLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL 7='it Nc. 3943 D Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : POASTLINE CESSPOO1440DW 1 SVS Address 1: 4225 BRIDGE LANE City St Zip CUTCHOUGUE 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 TOM ZIMMERMAN ------------------------------ Mailing Address 1 16 CANTABERRY ROAD, APT 2I ------------------------------ ------------------------------ City St Zip GREAT NECK NY 11021 -------------------- -- ---------- Property Address 1 265 SALT LAKE LANE ------------------------------ - ------------------ ----------- City St Zip MATTITUCK NY 11952 -------------------- -- ----------- Tax Map No. section 144.00 block 4 lot 9.000 Cross Street BAY AVENUE ---------------- ---------------- Building Permit Number Cross Reference: ------��%� � ------ Issue Date: 12/18/08 Elizabeth A. Neville ---- ----- Southold Town Clerk (TOWN SEAL)