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JUDITH T.TERRY � Oy` Town Hall, 53095 Main Road
TOWN CLERK ` y Z • P. O. Box 1179
,i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `C2 • 1� Fax(516) 765-1823
MARRIAGE OFFICER %#'*
RECORDS MANAGEMENT OFFICER = 491 �1" 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. 1563 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
REPLACE EXISTING CESSPOOL WITH NEW TYPE.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner BERDINKA, JOHN AND HELEN
Mailing Address 1 1330 FACTORY AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 1330 FACTORY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 142.00 block 1 lot 7.000
Cross Street SOUND AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/01/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 1 y< Town Hall, 53095 Main Road
TOWN CLERK y = ; P.O. Box 1179
vrft $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS : O
MARRIAGE OFFICER `y� '1�� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER : Ol • / Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 24, 1996
Transmitted herewith is a copy of application No. A1627 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for John and Helen Berdinka
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.
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OFFICE OF THE TOWN' CLERK ,,,,"""'
• Town of Southold i''lFf 0�
Judith T. Terry, Town Clerk ,'� ��� KCl/ Application 47/ 6 ..:17Town Hail, 53095 Main Road ;� � Construction
P. 0. Box 1179
Southold, New York 11971 :
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