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JUDITH T.TERRY �� y1 Town Hall, 53095 Main Road
TOWN CLERK y 2 t P.O. Box 1179
Pry $ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ..c,� *�0 Fax(516) 765-1823
MARRIAGE OFFICER AV)
RECORDS MANAGEMENT OFFICER �l 1 �► ,��� 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. 1401 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 AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner CHRISTAFOROU, GEORGE
Mailing Address 1 25-20 33RD STREET
City St Zip ASTORIA NY 11102
Property Address 1 895 CENTRAL DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 26 lot 2.000
Cross Street LUTHERS ROAD
Building Permit Number Cross Reference:
Issue Date: 10/17/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
11111
, //77.67
JUDITH T.TERRY Town Hall,53095 Main Road
• TOWN CLERK i H Z 1 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O 1Southold,New York 11971
MARRIAGE OFFICER : y� Q�it Fax(516)765-1823
RECORDS MANAGEMENT OFFICER o./ * �a,•0' Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,,i"�
OFFICETOWN OFiSOUTE HOLD WN CLERK 'r-= - �� q.,
TO: Southold Town Building Department
5
FROM: Linda Cooper, Southold Town Clerk's Office '3 f '' ' 1 1995
DATED: October 11, 1995
BILICI
Transmitted herewith is a copy of application No. A1452 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for George Christaforou .
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
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
/ A-7•41:4,
Signatur
Da fr----
OFFICE OF THE TOWN CLERK """"' •
-
Town of Southold ,�••'OC� �G Application Nor41
Judith T. Terry, Town Clerk y'-
Town Hall, 53095 Main Road Z !G ; Construction
P. O. Box 1179 ; c rn
Southold, New York 11971 tt� Alteration
Tele hone - 0 ire. $10.00 - Residential
P
(516) 765-1801 *�, ' $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 / /U
APPLICANT NAME:
APPLICANT ADDRESS: / ' ,'5'iy 9? -2—
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
147 u
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUE ' ION OR ALTE' ' T/"N: ,
OWNER OF PROPERTY: 4 ��/
OWNER MAILING ADDRESS: ' —
r: / 1 / D2_
OWNER PROPERTY ADDRESS: sQ ,O- ,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section_thfa _Block 2- Lot
CROSS STREET: S
BUILDING PERMIT NUMBER CROSS REFERENCE:
/4411L/ � "
Si.nature o Applic-
RECEIVED BY: 4„ or 40
own ler s Office
DATE: RECEI ED
OCT 1 1995
lawn Clerk Southold
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