HomeMy WebLinkAboutKuczynski ELIZABETH A. NEVILLE, MMCTown Hall,53095 Main Road
TOWN CLERK � �G�"" P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � Fax(631)765-6145
MARRIAGE OFFICER , ��IIIIIPiuii Telephone
(631)765-1800
RECORDS MANAGEMENT OFFICER " ) www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: October 4, 2018
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4662 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Marek Kuc , nski
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 w
DISAPPROVE
Comments:
Signature
......... ................. ....................W_
Dated
Town of Southold
P.O Box 1179
Southold, NY 11971
* * *
RECEIPT *
Date: 10/04/18 Receipt#: 248835
Quantity Transactions Reference Subtotal
1 Septic Permit- Construct- Resid, 4662 $10.00
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CASH $10.00 Peconic, Cesspool
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Peconic, Cesspool
P O Box 487
Laurel, NY 11948
Clerk ID: JENNIFER Internal ID:4662
ELIZABETH A.NEVILLE "` 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 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOCA 1OLD WASTEWATER DISTRICT
APPLICATION
COI�TSTR J TION or ALTERATION PERMIT
C �SSP"OOL or SEPTIC TANK
Residential @ $10 or Non esi dential @$25 Application No. L (02—
Permit No.
Applicant Name PECO IC CESSPOOL
Applicant Mailing Address P® SOS 487
Septic Tank or Ces pot
Brief Descriptio b P" osed taction or Alt ration
a�
Cor
_..�_
Location of Proposed Constructio Alt,eration- 5 r
Owner of Property- �-� °� �. _ (� ..5 Xci
Owner Mailing Address:
f
Owner Property Address: �
Name and phone number of co tact person jky" (�;,J
Tax Map No: Sect bn 3._K Block Lot
Cross Street
CONSTRUCTION RE - ON. NEW
NOTE- LOCATION MAP ST BE SUB TED4 APPLIC
QUIRES SU=atuxe�of2�pp
O' L
RECEIVED
OCT i� Ar Date
Received by:
Outhold'Town Clerk
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