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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ir) Southold, New York 11971
MARRIAGE OFFICER O � � Fax (516) 765-1823
*1D �I� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 993 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
ADDITION OF A NEW OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10'0" SEPARATION. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner BRANDES, LEE
Mailing Address 1 NEW SUFFOLK AVENUE
City St Zip NEW SUFFOLK NY 11956
Property Address 1 NEW SUFFOLK AVENUE
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 8 lot 2p0
Cross Street THIRD STREET
Building Permit Number Cross Reference:
Issue Date: 5/11/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
,• .? .
.4\JUDITH T. TERRY , . : TownHall, 53095 Main Road
TOWN CLERK : `• P.O. Box 1179
REGISTRAR OF VITAL STATISTICSSouthold, New York 11971
MARRIAGE OFFICER Q1(' ., Fax (516) 765-1823
�,�j�l Sit �1D Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department MAY
FROM: Linda Cooper, Southold Town Clerk's Office i , :�
s
DATED: May 6, 1993 ,,; 4
Transmitted herewith is a copy of application No. A1022 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Lee Brandes ,
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 lis
above and make the followi recommendation:
APPROVE - !/ MAY
793
DISAPPROVE rift air
-
COMMENTS: -4.'ee, /
w" 'AVATION INSPECTION
n" ;"RED
EXCAVATION INSPECTION Signature
'71"--2-44----
REQUIRED Da
' » OFFICE OF THE TOWN CLERK %%IFOA' -
Town of Southold t
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JulT. Terry, Town Clerk Application No.
TTwn Hall, 53095 Main Road '�cn Construction l�
P. O. Box 1179 `
Southold, New York 11971 0 Alteration
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Telephone01 �� �� Residential
(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 1/4/f,
APPLICANT NAME: t?"-----1-70e-"C‘ -' ---/-/f1,--1--(
APPLICANT ADDRESS: Fos. 6p,_ 972
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SEPTIC
/'9S'SEPTIC CESSPOOL I---.-
DESCRIPTION
DESCRIPTION OFFPROPOSED CONSTRUCTION OR ALTERATION
J
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSZCTION OR ALTERATION:
OWNER OF PROPERTY: / i
OWNER MAILING ADDRESS: # du.%_
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: L99 ,5-8
TAX MAP NO. : Section 1/7 Block .r Lot 2._
CROSS STREET: 3"
BUILDING PERMIT NUMBER CROSS REFERENCE:
°e'
Signature of '/41Alp icant
RECEIVED BY: /
itiajon Jerk's Office
DATE:
MAY X 1993
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