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ELIZABETH A. NEVILLE _ 'y� Town Hall, 53095 Main Road
TOWN CLERKy P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER Fax
�aO� Telephone (631) 765-1800
FREEDO F 1_NFOIRMATI9N..O.EEICER southoldtown.northfork.net
� I i0 FICE OF THE TOWN CLERK
�1L OCT — 7
2002 TOWN OF SOUTHOLD
BLrG 'T
TO: TOW§.oi thol-N- ding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 4, 2002
Transmitted herewith is a copy of application No. 3030 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Will Paulson
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.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE C�R _ �
/r 14e.
Comments: Maintain required setbacks from adjacent wells,buildingss,property lines and water
Bodies. EXCAVATION INSPECTION REOUIRED.
Signature
Dated
/v�//-az .,
OFFICE OF THE TOWN CLERK �FFOLk 3D
TOWN'OF SOUMOLD 3 QQ, Application No.
ELIZABETH A.NBVLLLB,TOWN CLL'RK
P.O.BOX 1179 < Construction
SOUTHOLD.NEW YORK 11971
Alteration
Telephone ij �.a0� $10.00 - Residential
(G31) 765-1800 l' JOL $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
i
Permit No.
Fee $
DATE - D?/
APPLICANT NAME: PEQONIC CESSPOOL
APPLICANT ADDRESS: P. 0. Box 972
MATTITUCK, NEW YORK 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
I
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1411-11
OWNER MAILING ADDRESS: / '7q5— 4!'p� ^+� ','Al 9g/
OWNER PROPERTY ADDRESS:
X14-7T.' 741 c_ k
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ,Block �'`o'77 Lot —'7—
CROSS STREET:
BUILDING PERMIT NUMBER CROS;> REFERt i(_E:
f
Signature of Applica
RECEIVED BY: LqewkA�
Town lerk's Office
DATE: leg— Gt,— ( Z
&
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S771 52-0,?,/0. N101F LONG ISIAND c
UGHMG COUP�AY
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SURVEY
MA
NUMBERS REFER TO 'MINOR SUBDIVISION TOWN C
FRANK MURPHY GARDEN CENTER SUFFOLK
1000 -
io
6lip SCA
A rl
i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 'J QQG� Application No.-(30 ap
EUIZABET11 A.NBV111.8,TOWN CORK
P.O.BOX 1179 !� Construction
SOUIHOLD,NEWYORK 11971 om
Alteration
Telephone VDij' �0� $10.00 - Residential
(631) 765-1800 l' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT y
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
0
Permit No.
Fee $
DATE
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. Box 972
MATTITUCK, NEW YORK 11952
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTE'RATION
ji/8r1�+� O?J�-ei� ,r� - 'i�S'�:.tir. S'S�S'TB-iv.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: / 7°15' 41d' ^+11 Al Rd
OWNER PROPERTY ADDRESS:
1 '7 k
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /?-vl, Block 671-7 Lot_
CROSS STREET:
BUILDING PERMIT -NUMBER CROSS REFEREP-ICE:
Ae
Signature of Applica
RECEIVED BY: p
Town erk's Office
DATE: 1C9, Gt 6 Z
G0
PP0�-
O
O;r
619
N101F JODAN L07 2 '00
kiOLDING CORPLj t
0
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ho ISIAND ,00, Ile
v cowp�Ny 0 c
0
6(9
6
9SS.10- AO
4, SL
19
39. L
-7 -7
C)r)
95 D Pow
SURVEY (
MA
NUMBERS REFER TO 'MINOR SUBDIVISION TOWN C
)'RANK MURPHY GARDEN CENTER SUFFOLK
1000 -
to
SCA
.4 r%
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 10/04/02 Receipt#: 6712
Transaction(s): Subtotal
1 Septic Permit-Construct. Non-resid. $25.00
Check#: 6712 Total Paid: $25.00
Name: Peconic, Cesspool
P O Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Intemal ID:63183