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ELIZABETH A.NEVILLE $��O y �� Town Hall, 53095 Main Road
TOWN CLERK y -� , P.O. Box 1179
2 Southold, New York 11971
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REGISTRAR OF VITAL STATISTICS %%•O # Fax (516) 765-1823
MARRIAGE OFFICER iJi �1
RECORDS MANAGEMENT OFFICER �0 .1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER1 * 0,• '�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 82 N Residential Non-Residential X
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 BURRIESEI, ANTHONY
Mailing Address 1 9650 MAIN ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 NORTH FORK GRILL
9650 MAIN ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 1 lot 1 .000
Cross Street
Building Permit Number Cross Reference:
--- - -
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Issue Date: 7/30/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE t•, ay • Town Hall, 53095 Main Road
TOWN CLERK y -� , P.O. Box 1179
2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %%%°'0 Fax Fax (516) 765-1823
MARRIAGE OFFICER 4 '��� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER �'�f09iiii 0
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FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 29, 1998
Transmitted herewith is a copy of application No. NR1984 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Anthony Burriesi (North Fork Grill)
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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.
T4"L-1
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the followingjrecommendation:
APPROVE - k/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
gnature
1 I'% ell ct
Date
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JFFICE OF THE TOWN CLERK ��.''��Q�� '�- ,l(t4�
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Town of Southold ;�OCj� % Application W-o. i
Judith T . Terry, Town Clerk ; t, ' .i> •
Town Hall, 53095 Main Road -.4. 1 Construction _
P. O. Box 1179 ,`� �,� Alteration V
Southold, New York 11971 P
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�O�-e; $11) . 0;) Residential
Telephone _
( 516) 765 1801 -�0 4 f?`, . C�i\ Non Residential
T OWN ,,I SOOT HOL l)
SOUTHOLD WAS%ASTEWA I F R I:)ISPOS? DiST PICT
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APPLICAT ION
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CONST RU(_ ? ION o' ALTER AT ION PERMI T
SEPT H. 1 ANI -,, ( E SSPOOL-
Permit No.
-
Fee $
DATE '14 0 it
N.
APPLICANT NAME:
APPLICANT ADDRESS 4/ YL 9 L_
SEPTIC CESSPOOL n�
DESCRIPTION Of PROPOSE[) ( r)^:S I lin-i- I ION C1R Al I I' RA F ION
0.-1)'‘'‘- 6 ase,syfri-7. .,
/ ---'''' ‘ 4'2-74--"-`7 '. "1- 4•"1-1-N.
LOCATION MAP Mo,t he alta, lied ile, ok, i.ct;•, e permit may he :cite(I
LOCATION OF PROPOSE [) CONSTRU( TION OR ALTERATION .
OWNER OF PROPERTY • Al/(/ jOif" , /3Uki&E-5;
OWNER MAILING ADDRESS F65e /1�r,,e c. . /1_-ve
A1.9- 77 'c_4' 4', i.- //951_,
OWNER PROPER TY ADDRESS A/0/47A POI< k fi'rll7
!yi/9- 7)74-vr-
TELEPHONE NUMBER OF (_,ON I AC I PERSON . --�--
TAX MAP NO, : Section /_,Y --- ----Block - Lot 4Qo(o
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE :
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Xe-e- e--z-re____Aif
RECEIVED Signature of App . ant
RECEIVED BY : K�
—Tl - ier M80ffi , - -
DATE:
-- ----SouthOld'Town-Clerk . __.
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