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JUDITH T. TERRY : '' Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS 1 Southold, New York 11971
MARRIAGE OFFICER 0 �- 4 Fax (516) 765-1823
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(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 923 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF A NEW OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10' SEPARATION BETWEEN OLD AND NEW POOL.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner COLOMBO, DANTE
Mailing Address 1 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 137.00 block 1 lot 13.000
Cross Street TRACK AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/20/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
410,4
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JUDITH T. TERRY Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK ` D T ;
REGISTRAR OF VITAL STATISTICS , Southold, New York 11971
y . Fax (516) 765-1823
MARRIAGE OFFICER Telephone (516) 765-1801
OCT 5 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
October 15, 1992
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A9118 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
p&onrrc Cesspool for Dante Colombo
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.
GCac—
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - X
DISAPPROVE -
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OFFICE OF THE TOWN CLERK ,,,'",,"
Town of Southold �.''liAVOUr`'.
Judith T. Terry, Town Clerk ,�'��� �l/� Application No. 9�
Town Hall, 53095 Main Road !� ; Construction
P. O. Box 1179
Southold, New York 11971 tpl, r`,. Alteration
Telephone ,j. �• $10.00 - Residential
(516) 765-1801 'Ol 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 $
DATE iefrA fZ--/
APPLICANT NAME: -liegiii �,.
APPLICANT ADDRESS: /' / -f f7 2-
SEPTIC CESSPOOL
DESCRIPIJ,QN OF PROPOSED CONSTRUCTION • : ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: i) e</c& C. '/or-Pt f!}
OWNER MAILING ADDRESS: J/✓/4V&fliZ .. /7'4'47-*
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OWNER PROPERTY ADDRESS: �--
TELEPHONE NUMBER OF CONTACT PERSON: c2/J— 9G57
TAX MAP NO. : Section / 3 7 Block / Lot /3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Vbplicant
RECEIVED BY:
TerICIVEDc's Office
DATE:
OCT I 15P
umn Clerk Sold
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