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ELIZABETH A.NEVILLE c .c Town Hall, 53095 Main Road
TOWN CLERK • ti Z P.O. Box 1179
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1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ` y 1
MARRIAGE OFFICER \ '*0! ��0 111 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ,�11 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. 1917 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 PALIOURAS, R.
Mailing Address 1 P. O. BOX 393
City St Zip GREENPORT NY 11944
Property Address 1 65795 NORTH ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 104.00 block 13 lot 7.000
Cross Street MOORES LANE
Building Permit Number Cross Reference:
Issue Date: 8/19/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
4FFO . 7
ELIZABETH A.NEVILLE •hGy •� Town all, 5 095 Main Road
TOWN CLERK �� p 1 P.O. Box 1179
CO Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �y 111 Fax (516) 765-1823
MARRIAGE OFFICER ‘ ,L
RECORDS MANAGEMENT OFFICER : "v0 � ��, Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER l 1���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: August 17, 1998
Transmitted herewith is a copy of application No. 1994 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for R. Paliouras
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.
1
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.
ignatu e
5111 iqg
Date
OFFICE OF THE TOWN •CLERK �0,,,,,,
Town of Southold ,�'' Of ake I���
Application No.
Judith T. Terry, Town Clerk $��� Gy.�'►;`
Town Hall, 53095 Main Road ;< ; Construction_
P. O. Box 1179 : c rn Alteration
Southold, New York 11971 . 01
Telephone ,y0,l� �����'�1, $10.00 - Residential �
(516) 765-1801 Ol �, $25.00 - Non-Residential• `
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE` _. (J//3/- --1---_ --
APPLICANT NAME:___ __________ . ,/ .
APPLICANT ADDRESS:__ �,�____ .__ !i-____._�__—
SEPTIC CESSPOOL I
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
s
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR LTERATION :
OWNER OF PROPERTY : /Lv:Gk3 ._.
OWNER MAILING ADDRESS: ` Q _ -3-L3 - -- —_.
--,----se-A-,2z-t--'r' _________________ _
OWNER PROPERTY ADDRESS:
r 795-71/0/Z/
—
_ -
-trz
TELEPHONE NUMBER OF CONTACT PERSON :
TAX MAP NO. : Section /0V Block ___n_._ Lot 7
G R O sS STREET: ----A-- �_____--
BUILDING PERMIT NUMBER CROSS REFERENCE:_ ___
_ .�i�.�.. -//
RECEIVED Signature of Ap -'scant
RECEIVED BY : AUG 17 1998
Town Clerk's Office
DATE: Southold Town-Clic-------
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