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JUDITH T.TERRY ���_� tk,‘ Town Hall, 53095 Main Road
TOWN CLERK -
= P.O. Box 1179
vr- rn � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O
MARRIAGE OFFICER �1�' Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER °l * '. ,,.' 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. 1508 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 HENRY, JOHN P.
Mailing Address 1 MIDWOOD DRIVE
City St Zip CUTCHOGUE NY 11935
Property Address 1 MIDWOOD DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 3 lot 32.000
Cross Street PEQUASH AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/17/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
o�•StFFO(,tC t�
JUDITH T.TERRY ��� Town Hall, 53095 Main Road
TOWN CLERK ; N Z P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER if' 0 �s Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER : �I * �a�d� 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: July 17, 1996
Transmitted herewith is a copy of application No. 1573 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for John P. Henry
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.
Signatur- C—
Da -
OFFICE OF THE TOWN" CLERK ,,,'"""
Town of Southold
Judith T. Terry, Town Clerk
11046' C�Gy Application No. /5 ,3
Town Hall, 53095 Main Road !� Construction
P. O. Box 1179 ; o rn
Southold,
New York 11971 s t!'i Alteration
Telephone �,j, �,,����'1 $10.00 - Residential
'
r�
(516) 765-1801 _ .1 4 ,, $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $_ �/L
DATE ���' / / Cti
APPLICANT NAME: / / �� i/, -.;.-., 414111P
APPLICANT ADDRESS: �/, fiavy 972..-
SEPTIC CESSPOOL?
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION
�O,R ALTERAT ON:
OWNER OF PROPERTY: ,.7 Q - - " r
OWNER MAILING ADDRESS: -, i ca . ,,
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: f�
TAX MAP NO. : Section 1/0 Block 3‘ Lot 3 ?i
CROSS STREET: A -
BUILDING PERMIT NUMBER CROS REFERENCE:
nature o Applicant
RECEIVED BY :
Town Clerk's Office
DATE:
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