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JUDITH T.TERRY ��_� ytN Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
471
i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER : y � � Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER N. 491 $ ,•O Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER a••,••
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1782 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 WEBSTER, KEVIN & HALLOCK, LYNN
Mailing Address 1 7 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Property Address 1 7 MIDDLETON ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 40.00 block 5 lot 2.000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 12/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY i1 Gym Town Hall, 53095 Main Road
TOWN CLERK
= P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O �� Fax(516) 765-1823
MARRIAGE OFFICER . y
RECORDS MANAGEMENT OFFICER = 0( 41 **�,°�' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER - 9 "S.,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 15, 1997
Transmitted herewith is a copy of application No. 1856 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Cesspool for Kevin Webster
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recomm ations:
APPROVE
DISAPPROVE
Comments:
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Dated
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OFFICE OF THE TOWN CLERK „'"""''•..,
Town of Southold 0'"40D1./( "
Application No. /((---'3 }-'
Judith T. Terry, Town Clerk .`''k., G�:\
Town Hall, 53095 Main Road ; .' Construction L.-
P. O. Box 1179 p Mt
Alteration
Southold, New York 11971 : 01 .--___.___-._..-__
Telephone -yjjy0 �.DO�'�'�, $10.00 - Residential v
se,
(516) 765-1801 1 ' $25.00 - Non-Residential,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ lb..--
DATEy "11)117
APPLICANT NAME: -_...__A_r-1/-71.c. _� — _
APPLICANT ADDRESS: 43--v 97 _ _--�
SEPTIC CESSPOOL 1/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY : ' - j# ' SAS' /; -x
OWNER MAILING ADDRESS: //Gt
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:_ -- TG S'c."
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TAX MAP NO. : Section Block Lot
CROSS STREET: (___A ,___,AS' >
BUILDING PERMIT NUMBER CROSS REFERENCE:
- / 4( ' / - —
Sign;fl ire of Applicant
RECEIVED
RECEIVED BY:
0 EDIT Ow s Office
DATE:
Southold Town �I�iClerk ~`---------
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