HomeMy WebLinkAboutReed (2) SaJTHCLD VO TEVIATER d SPOSAL PERM T
CPERATI CN PERM T
SEPTI C TAN( or CESSPOCL
Cper at i on Per ni t W. 4459-R Pesi dent i al X Non-Pesi dent i al
Fee $ 10. 00 New Exi st i ng X
Farre Cf Ower JANE REED
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Nbi I i ng Address 1 215 KPAUSE FUO D
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Mai I i ng Address 2
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0 t y St Zip NATTI TUCK W 11952-0000
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Pr oper t y Address 1 215 KPAUSE ROAD
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Property
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Property Address 2
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City
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City St Z p NATTI TUCK W 11952-0000
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CiAner Tel ephone W. 631-298-5651
Tax Map W. sect i on 122. 00 block 5 1 of 7. 000
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Cross St r eet CLD J ULE LANE
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I ssue Dat e: 10/ 11/ 13 D i zabet h A Nevi I I e
-------- Sout hol d Town Clerk
(TCit N SEAL)
ELIZABETH A. NEVILLE,MMC ti� Gy Town Hall,53095 Main Road
TOWN CLERKp P.O. Box 1179
W 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS p • Fax(631)765-6145
MARRIAGE OFFICER 'J'
RECORDS MANAGEMENT OFFICER ��,� .��� Telephone oldt 7nny.go0
FREEDOM OF INFORMATION OFFICER www.southoldtownny.gov
OFFICE OF THE TOWN CLERK �—
TOWN OF SOUTHOLD
TO: Southold Town Building Department OCT 10 2013
f
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: October 10, 2013
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4166 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Jane Reed
Please review the application and location map and advise 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
I/
DISAPPROVE
Comments:
Signature
Dated
,r w
�osuFFo�,��o
O p
ELIZABETH A.NEVILLE 2 y� Town Hail, 53095 Main Road
TOWN CLERK CCA = P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS O Southold, New York 11971
MARRIAGE OFFICERy • �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER l �a0 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 @$l 0—v/or Non-Residential @$25 Application No.'
Permit No.
Owner Name1 ?
Owner Mailing Address
Owner Property Address 4 Z�2� /V 4 K"
rS—�
Owner Telephone No. �7 J�� C/ j�T ✓��—����
Tax Map No: Section Block Lot
Cross Street Ob LTe
Please check each that appli s: New Construction
Alteration to Existing System
Residential. � L —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 su with SCHD roval.)
Signa ure of Applicant Date
Received by:
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