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JUDITH T. TERRY : `; Town Hall, 53095 Main Road
TOWN CLERK : o
Fri • P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �. ��� Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ' ' ��O �
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� Telephone (516) 765-1801
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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. 1180 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL SERVICE
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 BOCCIA, EDWARD
Mailing Address 1 4520 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 4520 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 30 lot 3.000
Cross Street FLEETWOOD ROAD
Building Permit Number Cross Reference:
Issue Date: 8/12/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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• ,' *% Town Hall, 53095 Main Road
JUDITH T. TERRY Z L
TOWN CLERK : p rz P.O. Box 1179
Vs W Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = �. ,% Fax (516) 765-1823
MARRIAGE OFFICER �� si Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '- ,� * �'
FREEDOM OF INFORMATION OFFICER • '���„�iiiii°°�
OFFICE OF THE TOWN CLERK 117 IE r
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office ` TOWN NOF46Pr•
OF SO(1THOL0
DATED: August 1, 1994
Transmitted herewith is a copy of application No. A1224 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Edward Boccia
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 - Z/
DISAPPROVE - EXCAVATIN wspEcnoro
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Signature /
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Date ”
OFFICE OF THE TOWN CLERK ,%' '"
Town of Southold .�''�c�FF14 ! �" }
Town Clerk �'� �G Application No. /�`='
Judith T. Terry, a, y';
Town Hall, 53095 Main Road _ z . Construction fr-
P. O. Box 1179 Alteration .�--
Southold, New York 11971 s�
Tele hone =0 �Qi� $10.00 - Residential � �
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(516) 7p65-1801 . '1ilig��, �' $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 l L/ 029, /99
APPLICANT NAME: -
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APPLICANT ADDRESS: ? CI .. 9 2_.
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Z,
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATIN: 1
OWNER OF PROPERTY: 4,-. 12-C.C..-6...a.„.
OWNER MAILING ADDRESS: "54.5.721.40 ,/1 ' /
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:c9. 7 1
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TAX MAP NO. : Section /1/) Block 30 Lot 3
CROSS STREET: jleel-wood /2oc d
BUILDING PERMIT NUMBER CROSS REFERENCE:
44-'4, //
Signatur- of AID. fant
:
RECEIVED BY.
Town Clerk's Office
DATE:
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