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JUDITH T.TERRY � _ OGy� Town Hall, 53095 Main Road
TOWN CLERK 2 y2 P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS `� n1�1� Southold,New York 11971
MARRIAGE OFFICER 414 �� Fax(516) 765-1823
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RECORDS MANAGEMENT OFFICER `i Ol ���JI Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,,•'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1683 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner ASHTON, MARGARET
Mailing Address 1 P. O. BOX 457
City St Zip MATTITUCK NY 11952
Property Address 1 795 LOVE LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 3 lot 7ff�
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 6/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town Hall, 53095 Main Road
112 1
•4,y0 O�i \ 5 P.O. Box 1179
soI1' •�� Southold, New York 11971
JUDITH T.TERRY �`•1 TTLEPHONE
TOWN CLERK f516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
D May 15, 1997
Transmitted herewith is a copy of application No. 1749 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Pernnir. Cesspool for Margaret Ashton •
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 this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
nature�
Date
OFFtd OF THE TOWN CLERK ' „ ''',,, -_ / C�
• Town of Southold ,,”`I ��F�i� `
Judith T. Terry, Town Clerk , ��� (1/y'; Application No.
Town Hall, 53095 Main Road �e� Construction
P. O. Box 1179 ; C=1 rn ; Alteration
Southold, New York 11971 tts ��
Telephone y0 ��'�' $10.00 - Residential
p
(516) 765-1801 ��.1 �,� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE Aay /0; / 9 7
APPLICANT NAME: /
APPLICANT ADDRESS: ,?e 7a-7/)4 9 77.-
SEPTIC
2SEPTIC CESSPOOL t/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
If at
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: /,D � /3,t1}/
//4•1z,
OWNER PROPERTY ADDRESS: 79 /0--,
TELEPHONE NUMBER OF CONTACT PERSON: 2-frr-- 96
TAX MAP NO. : Section / V/ Block 3 Lot 27
CROSS STREET : -21ir2Z
BUILDING PERMIT NUMBER CROSS REFERENCE: —
Signature f Applicant
RECEIVED BY : _—
Town
Town Cle ice
DATE: - 1-5-1997
Southold Town Clerk
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