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SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3980 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1: P 0 BOX 487
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner THOMAS AIUTO
Mailing Address 1 29 TULIP GROVE DRIVE
City St Zip LAKE GROVE NY 11755
Property Address 1 3000 REEVE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 100.00 block 1 lot 6.000
Cross Street BAILEY BEACH ROAD
Building Permit Number Cross Reference:
Issue Date: 9/28/10 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
11,i%OF S007:ELIZABETH A.NEVILLE,RMC,CMC ,' �O l0 Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
va
REGISTRAR OF VITAL STATISTICS � � Southold, New York 11971
MARRIAGE OFFICER `` . �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICERTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ='rear(,�II,i'°�, southoldtown.northfork.net
01°
OFFICE OF THE TOWN CLERK D E c 0 V 5
TOWN OF SOUTHOLD
SEP 172010 J
TO: Southold Town Building Department
BLDG.DEPT.
FROM: Carol Hydell, Southold Town Clerk's Office TOWN OF SOUTHOLD
DATED: September 17, 2010
Transmitted herewith is a copy of application No. 3980 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Thomas Aiuto
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
Carol Hydell
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature FtVir
9 s yA
Dated
EL RETH A.NEVILLE itO
ZA4 : Town Hall,53095 Main Road
TOWN CLERK o P.O.Box 1179
co,REGISTRAR OF VITAL STATISTICS ' Southold,New York 11971
MARRIAGE OFFICER • *" ,' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ';yd0 �0*0' Telephone(631)765-1800
FREEDOM OF INFORMATION OFFICER =:'t * 4,�'0 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 V or Non-Residential @$25 Application No.3 9 WO -
Permit No.
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P• o• BOX __487
LAUREL, NEW YORK 11948
Septic T r'- or Cesspool
Brief Desc ' n of Propos onstructwt�o re 'l�L
cess &-r�.rCG,
C e. rzi_e_---t
Location of Proposed Construction/Alteration:—ti
Owner of Property: 1 rt 0 �S ra 1.6o
Owner Mailing Address: ,9 G-.),-,0--N1/4-k, Dr
yjzz Grj,_o_v.e_liut 117s-,5
Owner Property Address: 3 000Reeve 1a-�,/
• fleaf1'?1c4, NY //95e
Name and phone number of contact person Le.472574.t —893°2
Tax Map No: S tion I C O i.Block / Lot Co
Cross Street6o,_: I Te_ck())
NOTE: LOCATION MAP MUST BE SUBNIITTE 0 ' TH APPLIC.S1 ON NEW
CONSTRUCTION REQUIRES SURVEY WITH H -4 '42. DEPARTME 7.1'PROVAL
etl "
Si a,,a of Applicant Date
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Received bye-AO—A .,,�Jr -
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