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JUDITH T.TERRY � = t‘N Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
47 ,v' Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1 Fax(516) 765-1823
MARRIAGE OFFICER V y*/) ,�I� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER .� s �
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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. 1681 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 A NEW TYPE.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner MINTON, CHARLES AND MARY
Mailing Address 1 P. O. BOX 778
City St Zip MATTITUCK NY 11952
Property Address 1 5195 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948
Tax Map No. section 128.00 block 2 lot 20.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 6/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i < •
Town Hall, 53095 Main Road
'4 ' P.O. Box 1179
.0)1Southold, New York 11971
41.
JUDITH T.TERRY `•��� ���• TELEPHONE
(516) 765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 15, 1997
Transmitted herewith is a copy of application No. 1747 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Charles and Mary Minton
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.
RECEIVED
Aw .
JUN 4 1997 Signature
Southold Town Clerk
Date
OFFICE OF THE TOWN CLERK '''
Town . I�
Town of Southold t' 'OCj� FO��l'�/ Application NcS. 'I l
Judith T. Terry, Town Clerk ,
Town Hall, 53095 Main Road �� Construction
P. O. Box 1179 ; 1=3 n, Alteration
Southold, New York 11971
Telephone $10.00 - Residential
(516) 765-1801 $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 Qy /,2l /997
APPLICANT NAME: /e _ ri_zA,-
APPLI CANT
ADDRESS: "�i ewf �" 72- �/_ �- --------
r _ 41' / // C
.7 _
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
4.01. 411. 41
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCT! N OR ALTERATION:
OWNER OF PROPERTY :
`���� `/
OWNER M G ADDRESS:_ Si 7 `T A M
(OWNERPROPERTYADDRESS:.
TELEPHONE NUMBER OF CONTACT PERSON: ' UO s I
TAX MAP NO. : Section_, 24( _Block 2i' Lot 7/ e — —
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED Signatur of Applicant
RECEIVED BY : MAY 1 5 1997
Town Clerk's Office
DATE: Southold Town Clark
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