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JUDITH T.TERRY �� Gyj•
Town Hall, 53095 Main Road
TOWN CLERK t
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Z P.O. Box 1179
1,7 t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ` O
MARRIAGE OFFICER � ijJ 0�� Fax (516) 765-1823
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RECORDS MANAGEMENT OFFICER •_ 49l jig 're." 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. 1456 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 OLD 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 FOSTER, JIM
Mailing Address 1 2515 BAYWATER AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 2515 BAYWATER AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 75.00 block 4 lot 26.000
Cross Street SOUTH HARBOR ROAD
Building Permit Number Cross Reference:
Issue Date: 4/09/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY � � Town Hall, 53095 Main Road
TOWN CLERK ; y = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` O
$ Southold, New York 11971
MARRIAGE OFFICER � yijJ 0� 1�, Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER l �►����� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,.'s�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 29, 1996
Transmitted herewith is a copy of application No. 1515 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Jim Foster
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.
icce
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.
'! C
RECEIVED ,;.
Signatu e
APR 9 1996
Date
Town Clerk Southold
OFFICE OF THE TOWN CLERK ��'"""
Town of Southold '.",' flair
Town Clerk �' �� C'
Judith T. Terry, / Application No.
y
Town Hall, 53095 Main Road � °' Construction
P. O. Box 1179 ; v 1-71 ;
Southold, New York 11971 cn yc �• Alteration
Tele hone ;y0 - Q ��•� $10.00 - Residential l/
(516) 7p65-1801 "t ��' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME:
APPLICANT ADDRESS:`; p , ,9 72-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: 'r
7/7/
OWNER OF PROPERTY: f-10171h'\d
OWNER MAILING ADDRESS: 122-515-
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OWNER PROPERTY ADDRESS: Sf. 4 ,2 L' '197/
TELEPHONE NUMBER OF CONTACT PERSON: 9 '— 9 S8)"
TAX MAP NO. : Section % Block 4 Lots,
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Appl' ant
RECEIVED BY:
Town Clerk's Office
DATE: 3 - Y r�
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