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Telephone
(631.) 765-1800
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Application ~
COI1$\rucUon
Alteretlon
$10.00 -Residential
$25,00 - Non-Resldentlel' ,t.-
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IlUZAIB1Ii . "I\IYII.I.I. TOWN CLIlllX
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1OUIH0lD. NIIW YORK 11971
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Perml1 No.9
Fee '$
DATE 3/1./01,
, APP&;ICANT NAME: PECONIC CESSPOOL
APP!,ICANT ADDRESS:
P. O. BOX 972
MATTITUCK, NEW YORK 11952'
SEPT;IC_CESSPOOL_
. DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOC~TION MAP: Must be atta'ched hereto before permll may be Issued.
~~"I'lqti Of PROPO~ED CONSTRUCTION OR !\LTl:RATION:
';'PWNER' ClF PRQPEim: ::r k III k.. Ll e.
if9WNERMAILING ADDRESS: P.O P::>~ (;.07
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OWNER PROPERTY ADDRESS: I ~"!'iO M ILM'\ .n...I
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'TELEPHONE NUMBER OF CONTACT PERSON: ~'i-'H.s-t
TAX MAP NO.: Section IllfL611lock-!L, _Lo' ?If, o,,~
~SSTREET: ~~ ~
BUILDING PERMIT NUMBER CROSS REFERllCE: (lrr> ",~__ ,."..
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ELIZABETH A. NEVILLE
TOWN CLERK
Town Hall, 53095 Main Road
P.O, Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
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REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANA.QE1P'i'F~CER
F.REEB9linIF'1$fFfi>~'\1,O FICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO:
Southold Town Building Department
FROM:
Linda 1. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3584 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Peconic CessDool
Please review the application and location map and advise if the project has received Suffolk County
Health Department approval and if this office may issue the permit.
Please complete the form below and return it to me.
Linda J, Cooper
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I have reviewed the apPli7ation d location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
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Signature
Lf...-/fVbj,
Dated
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TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [] ROUGH PLBG.
[ ] FOUNDATION 2ND [] INSULATION
[ ] FRAMING I STRAPPING [)Q FINAL ~
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
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INSPECTOR~~
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