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JUDITH T.TERRY ��� yt• Town Hall, 53095 Main Road
TOWN CLERK •• y Z • P.O. Box 1179
^t � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER \ 0 yif' • Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER �l * *ea” 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. 1458 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 CAVED IN 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 WEINER, NORMAN
Mailing Address 1 905 WESTVIEW DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 905 WESTVIEW DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 139.00 block 1 lot 17.000
Cross Street BROWER ROAD
Building Permit Number Cross Reference:
Issue Date: 4/09/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
,i' S� FIR,l( (17
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JUDITH T.TERRY � = yet Town Hall, 53095 Main Road
TOWN CLERK y = ; P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER = � pl1�� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ./ * -►,0d 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: April 5, 1996
Transmitted herewith is a copy of application No. A1518 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Norman Weiner
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
RECEIVED
above and make the followin commendation:
APR 5 1996APPROVE -
DISAPPROVE •
-
towm Berk Southold
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature
ILcS� Jib
Dat
a
OFFICE OF THE TOWN. CLERK ,,,,,,,,,,,
A
Town of Southold C� 0t�^ - Application f �r
Judith T. Terry, Town Clerk ��' y Gy: PP Ni
Town Hall, 53095 Main Road � Construction
P. O. Box 1179 _ ` Alteration
Southold, New York 11971
Telephone -y�,� $%1��f�'f $10.00 - Residential
(516) 765-1801 _ 1 'r
,, $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
APPLICANT
APPLICANT ADDRESS: /9,v p"- 971.
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
• 714-4,A--' g,.."
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 905
~�wf ,t . // SS7 _ _
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: d-9 • G 5V-
TAX MAP NO. : Section / 3 y Block G/ Lot /
CROSS STREET:
BUILDING PE1WUAR CROSS REFERENCE:
Mid
100 C Signa re of Applicant
RECEIVED BY:
Town ' Jerk's Office
DATE:
.
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