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ELIZABETH A.NEVILLE �=`` Oy��� Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
Southold New York 11971
REGISTRAR OF VITAL STATISTICS �� Fax (516) 765-1823
MARRIAGE OFFICER �`41*0 ��O�,.S Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
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. 1834 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 MARKHAM, FREDERICK AND LINDA
Mailing Address 1 43 WOODRIDGE ROAD
City St Zip WELLESLEY MA 2181
Property Address 1 875 MASON DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 5 lot 37.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 4/10/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE „s g`1O tki'4 P I Town Hall, 53095 Main Road
TOWN CLERK ; p - P.O. Box 1179
CO
- - Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • v'
a� � Fax (516) 765-1823
MARRIAGE OFFICER L ifi s
RECORDS MANAGEMENT OFFICER 1� a0 �1� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER f,c4 1���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 1908 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Fred and Linda Markham •
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
* * * * * * * * * * * * *
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.
ySignat e
y/i/.4 r-
Date
OFFICE OF THE TOWN •CLERK ''��,,'�FO� ,-
Town of Southold . ke
Q '
Application No./96
Judith T. Terry, Town Clerk pP
Town Hall, 53095 Main Road Construction
P. O. Box 1179 ` c ' Alteration
Southold, New York 11971 ��
Telephone ,��0 �� •
������ $10.00 - Residential
(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 $
DATE__ 3/0 "
APPLICANT .NAME: t>" // _, j///'
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 4___
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: / 1
OWNER OF PROPERTY : -i41.4t[& �'//GG2��%1r-!✓yam _
OWNER MAILING ADDRESS: kao �l„ •
OWNER PROPERTY ADDRESS: 875 42 •,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 10 ' Block j Lot 7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
-•rLi[.
Signature of if,.plicant
RECEIVED BY : i
To n C er 's Office
DATE:
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0Peconic
eepooe
SEWER& DRAIN SERVICE
P 0. BOX 972 BRAY AVENUE MATTITUCK, NEW YORK 11952
(516) 298-9658
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