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JUDITH T.TERRY � yid `� Town Hall, 53095 Main Road
TOWN CLERKN P.O. Box 1179
n> t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS `F��� Fax(516) 765-1823
MARRIAGE OFFICER y\\,..4/#49
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RECORDS MANAGEMENT OFFICER �� Jig go 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. 1738 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 WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner BRUNO, NICK
Mailing Address 1 ALPINE WAY
City St Zip HUNTINGTON NY 11743
Property Address 1 52534 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 63.00 block 5 lot 13.000
Cross Street OAKLAWN AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 11_ t Town Hall, 53095 Main Road
TOWN CLERK ; co,
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O � Southold, New York 11971
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MARRIAGE OFFICER L�r& 0� Fax(516) 765-182365-1
RECORDS MANAGEMENT OFFICER ••.,...:491 * 4••••••• 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: September 26, 1997
Transmitted herewith is a copy of application No. 1812 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Nick Bruno
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.
ignatur
Date
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OFFICE OF THE TOWN CLERK ",,"""'-
Town of Southold �••01c)\\VULK�+o \
Application No./k"/
Judith T. Terry, Town Clerk ;' O Gy;
Town Hall, 53095 Main Road ; � Construction
P. 0. Box 1179
Southold, New York 11971 522 ,' Alteration
Telephone D,j• / $10.00 - Residential
(516) 765-1801 '-et IP•
$25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE V" 57
APPLICANT NAME: eed-d,"(71-11
APPLICANT ADDRESS: Ae• G7 97.2-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSEb "CONSTRUCTION
S� OR ALTERATION
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‘7‘.(2-g4..) —
LOCATION
;fit-g4JLOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCT ON 0 ALTERATION:
OWNER OF PROPERTY :
OWNER MAILING ADDRESS: / / 4,1
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OWNER PROPERTY ADDRESS: 5 a tj' S nek4A.4-,
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TELEPHONE NUMBER OF CONTACT PERSON : 0.1 -CI (0 Sr
TAX MAP NO. : Section G 3 Block S Lot / l
CR•65r STREET: 0 A-c I Ilk) N fr v it-
BUILDING PERMIT NUMBER CROSS REFERENCE:
,k.Lt- C/111_,"
Signature of Applic
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RECEIVED BY : 1 A 'tv
Town Clerk' Office
DATE: c/'%'Z(o/9�
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