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Construction
Alteration
$10.00 -Residential
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERA1
SEPTIC TANK or CESSPOOL
Permit No.
DATE
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS:
P. O. BOX 972
MATTITUCK, NEW YORK
11952'
SEPTIC CESSPOOL ~
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION
· OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OF PROPOSED CONSTRUCTION OR ,ALTERATION:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO.: Section /1'~ Block
CROSS STREET:
¥
BUILDING PERMIT NUMBER CROSS R, EFEF~.ENCE:
RECEIVED
Town Clerk'~ Office-
Signature q~' Applicant
JIM WELLS
325 ItOWARD AVENUE
MATTITUCK
,Deeo ie
SEWER & DRAIN SERVICE
P.O. BOX 972 BRAY AVENUE MATi-ITUCK, NEW YORK 11952
(631) 298-9658
September 5, 2003
Mr. Mike Verity
Building Department
Dear Mr. Verity:
Enclosed is the revised sketch for the proposed cesspool for Jim Wells, 325 Howard
Avenue, Mattituck.
Very truly yours,
Richard Magill
Enclosure
Hand Carried