HomeMy WebLinkAboutCummings, Polly T
•
.S 0p _
D '
4* , Gyp
JUDITH T. TERRY ►� Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER *O ON(' •�� Fax (516) 765-1823
_ 741 + 1b �� Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 937 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
ADDITON OF OVERFLOW TO AN EXISTING SYSTEM.
APPROVED WITH CHANGES (SEE ATTACHED) . HOLD 10' SEPARATION AND 75'
FROM WATER SUPPLY. EXCAVATION INSPECTION REQUIRED. CALL FOR AN
APPOINTMENT.
Name Of Owner CUMMINGS, POLLY
Mailing Address 1 WELLS ROAD
City St Zip LAUREL NY 11948
Property Address 1 WELLS ROAD
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 8 lot 3.000
Cross Street ALBO ROAD
Building Permit Number Cross Reference:
Issue Date: 11/27/92 Judith T. Terry
Southold Town Clerk
-- _ (TOWN SEAL)
(?L:E!) '7
00 - G�
JUDITH T. TERRY % Z ''� ;
. •
OFFICE OF THE TOWN CLERK ,,,'",,„
Town of Southold ,••1'. c\\ FOUK`'OG Application No.
/ Y
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. 0. Box 1179
Southold, New York 11971 �i:=1 �,� Alteration
Telephone 2.0a $10.00 - Residential
(516) 765-1801 '".l �� °,
�' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: Xj2...c.„20-7. L � 4, -. i4
APPLICANT ADDRESS: 04? P7
SEPTIC CESSPOOL
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:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: --
TELEPHONE NUMBER OF CONTACT PERSON: 2-97-16
TAX MAP NO. : Section /2-4 Block Lot 3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicar17/a./(
RECEIVED BY:
Town Clerk's Office
DATE:
di 95-7
0101
atte de,..x it e ep 1.10
Le)
,
411, 11..
oef • /
'KY •
roe)
tiy
.(&
•
•