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SCUTHCLD VIASTEVIATER DI SPCSAL PERM T
CCNSTRUCTI CN CR ALTERATI CN PERM T
SEPTI C TAMC or CESSPOOL
Per ni t Nb. 4241 R Resi dent i al X Nbn-Rosi dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSLED TO
Name : PECCN C CESSPOOL
Address 1: P O BCX 487
a t y St Zip LAUREL NY 11948
Descr i pt on of Proposed Const r uct i on or Alt er at i on
Al]] TI CN TO EXI STI N3 SYSTEM
APPRCvED AS SU3M TEED NAI NTAI N REQJ RED SETBACKS FROM ADJACENT
WELLS, BU LDI NGS, PROPERTY LI NES AND MATER BCD ES.
EXCAVATI CN I NSPECTI CN REQJ FED
Isne CF Owner ANTHONY NALRO
Mai I i ng Address 1 61 NAPLE DRI VE
Ci t y St Zi p NEIN HYDE PARK N ' 11040
Property Address 1 650 RAIVBLER ROOD
a t y St Zi p SCUTHCLD NY 11971
Tax Map Nb. section 88. 00 bl ock 5 I of 21. 000
a oss St r eet BAYVI EW AVER
Bui I di ng Per m t Minter Cr oss Ref er ence:
I ssue Dat e: 6/ 10/ 14 El i zabet h A Nevi I I e
Sout hold Town a er k
.
ELIZABETH A. NEVILLE,MMC l OF co ''
( I Town Hall,53095 Main Road
TOWN CLERK i p A 1 P.O.Box 1179
t y 2 � Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
Fax(631)765-6145
MARRIAGE OFFICER :O* 0. Telephone(631)765-1800 00
RECORDS FIAGEMENT OFFICER Ol* 0O. www.southoldtownny.govFREEDOM OF INFORMATION OFFICER i,
OFFICE OF THE TOWN CLERK I 1 I
TOWN OF SOUTHOLD . fl j MAY 2� ! I i 1
U �I 2014 i�J
TO: Southold Town Building Department I
T In
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 28, 2014
Transmitted herewith is a copy of application No. 4241 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Anthony Mauro 88-5-21
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 me.
* * * * * * * * * * * *
I have reviewed the application and loc ion map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
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Signature
‘/41S----/f‘
Dated
'irrei..
Town Hall,53095 Main Road
ELIZABETH,A.NEVILLE i
TOWN CLERK ; P.O.Box 1179
co m Southold,New York 3.1971
REGISTRAR OF VITAL STATISTICS 1,,,to
4171 Fax(631)765-6145
�
MARRIAGE OFFICER � ,' Telephone(631)765-1800
RECORDS OFFICER 'S T-,•'' southoldtown.northfork ner
FREEDOM OF INFORMATION OFFICER ,,•
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-Residentialc(Q$25 Application No. LY,,? (//-
Permit No.
Applicant Name PECONIC CESSPOOL
Applicant Mailing Address P• 0• BOX 487
LAUREL, NEW YORK 11948
Septic Tom- or Cesspool V
Brief Dem:Sion of Proge,sed Construction�tion
Location of Proposed Con ictjion/Alteration: n„G �®
Owner of Property: A GI h i �'l
Owner Mailing Address: f V a9
k 177
/lieeA/ flgofk ad-, itiK U0 410
Owner Property Address: C50 tto �%/`. ` 1
. c NY 1197
Name and phone number of contact person L&6+," 3-1•Z — d /3,
Tax Map No: Section ?8' Block S Lot ok
Cross Street 2 (9v 11 ' f Gv
NOTE: LOCATION MAP MUST BE SUBM TIED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEAT. DEPAR APPROVAL
Signature of Applicant Date
Received by: 5/2 /k/ •
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