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JUDITH T. TERRY z : Town Hall, 53095 Main Road
TOWN CLERK p T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS ; �� Southod, New York 11971
MARRIAGE OFFICER yQ O� �, Fax (516) 765-1823
or4b.. �1Drr� Telephone (516) 765-1801
41
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 979 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
REPLACE EXISTING CESSPOOL WITH NEW TYPE.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED.
Name Of Owner ALLISON, DAVID
Mailing Address 1 820 EAST ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 820 EAST ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 71 lot - C cc'
Cross Street FLEETWOOD ROAD
Building Permit Number Cross Reference:
Issue Date: 4/23/93 Judith T. Terry
Southold Town Clerk
(TOWN SFAI )
'' FFOIK
.64
JUDITH T. TERRY %,, L : Town Hall, 53095 Main Road
TOWN CLERK T • P.O. BOX 1 179
REGISTRAR OF VITAL STATISTICS �` Southold, New York 11971
MARRIAGE OFFICER =yQ ��0�' �, Fax (516) 765 1823
i� Telephone (516) 765-1801
'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
2
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 9, 1993
Transmitted herewith is a copy of application No. 1004 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Cesspool a/c David Allison •
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.
Linda J. Cooper
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE n n n
Comments: O� o -�.t`X,c' s r9 b-,n CdtGt
ricx..k. iajt _ (1-54
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Signatu
444 Dated
' OFFICE OF THE TOWN CLERK ,c3IFOLA'1,"
Town. of Southold ,&_N) Application No. 72) G ,(
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction 1------
P. 0. Box 1179 *W‘$ Alteration
Southold, New York 11971l [ NOV� �� Residential L�
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. r0
Fee $ / 0 .00
DATE Apr."/ g /99.
APPLICANT NAME: �w
APPLICANT ADDRESS: iO 972.
gk
SEPTIC CESSPOOL Y"
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATI :
/,��jjss
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: Fc9c2 �
1,64_6 , ' // q 3S—
OWNER PROPERTY ADDRESS: --
TELEPHONE NUMBER OF CONTACT PERSON:c9 '9 ,S ,f
TAX MAP NO. : Section 1/0 Block Lot
CROSS STREET: �l •t'
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Appli t
RECEIVED BY: -, /Le __
Town Clerk's Office
DATE: W9/9
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Peconic eatipoof
SEWER& DRAIN SERVICE
P 0. BOX 972 BRAY AVENUE MATTITUCK, NEW YORK 11952
(516) 298-9658
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