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JUDITH T.TERRY `II Town Hall,53095 Main Road
TOWN CLERK N az ; P.O.Box 1179
REGISTRAR OF VITAL STATISTICS
%;,%80.O$ 417 Southold,New York 11971
y� � Fax(516)765-1823
MARRIAGE OFFIR RECORDS MANA EMENT FFICER : .� jig 'aOdll 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. 1381 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 CRABTREE, ALBERT E. & CLAIRE
Mailing Address 1 3080 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948
Property Address 1 3080 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948
Tax Map No. section 128.00 block 10 lot 6.000
Cross Street BRAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/11/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK k a! ; P.O.Box 1179
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0 1s Southold,New York 11971
MARRIAGE OFFICERREGISTRAR OF VITAL STATISTICS = �, ,�N. �� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER '- �.( `1►a�e'e Telephone(516)7654800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department AUG 3 0 1995
FROM: Linda Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. A143 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Albert E. Crabtree •
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 -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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OFFICEOFF THE TOWN CLERK '
V. Town of Southold e'"', Ff kti -, At/[J
Judith T. Terry, Town Clerk '''W 4
0 Application No. l 7
Town Hall, 53095 Main Road !4 ; Construction t-----
P. 0. Box 1179 " "
Southold, New York 11971 's 4E;
-..V) . Alteration
$10.00 -Residential L—
Telephone
(516) 765-1801 _ 1 4t "' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. .
Fee .$ /0 --�
DATE 8J4
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APPLICANT NAME: 4.--fh; ate--+e--- --e
APPLICANT ADDRESS: ,Xot / ....„-V
SEPTIC CESSPOOL -1/-
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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A
LOCATION MAP: ' Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRRU TION OR ALTERATION:
OWNER OF PROPERTY: / /4 x,7 A' eA4I,a_
OWNER MAILING ADDRESS: "1/9-/ a- ,44-1ar-
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: —Ar(i
TAX MAP NO. : Section /)-e Block its Lot A
0146:58--STREET:
BUILDING PERMIT NUMBER CR SS REFERENCE:
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Signa a of Applicant
RECEIVED BY: / C(/
Q �'s'o n Clerk's Office
DATE: U 6
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