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JUDITH T. TERRY ►► Town Hall, 53095 Main Road
TOWN CLERK p T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS ; Southold, New York 11971
MARRIAGE OFFICER -=yQ O� ��, Fax (516) 765-1823
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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. 987 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOL
Address 1 : P. O. NOX 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. EXCAVATION INSPECTION REQUIRED.
Name Of Owner BROOKS, JOSEPH AND SUE
Mailing Address 1 5535 WESTPHALIA AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 5535 WESTPHALIA AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 5 lot 12.000
Cross Street COX NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 4/27/93 Judith T. Terry
Southold Town Clerk
(TOWN SFAL 1
,$4tsiyL It Town Hall, 53095 Main Road
JUDITH T. TERRY
TOWN CLERK : p r= P.O. BOX 1179
REGISTRAR OF VITAL STATI$ ICS ..0- i' W%�` Southold, New York 11971
VO �. t Fax (516) 765-1823
i �FIRCI\ r` ,r -40 1 alt %W �..� Telephone (516) 765 1801
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,� j APR 2 61993
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 26, 1993
Transmitted herewith is a copy of application No. A1013 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Joseph and Sue Brooks .
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: 4P,44111,0
APPROVE - 1C ``
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DISAPPROVE -
COMMENTS: Gt.,, A.,,a,i, 1 >r.4‘. gd1'e aztO cJA . 042P
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' OFFICE OF THE TOWN CLERK c \ FU(A'
Town of Southold COQ Application No. /�/
.Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179 `
Southold, New York 11971 u1� Alteration
Telephone 01 41 �� �� Residential L�
(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. (® i
Fee $ /0
DATE V '22/y 3
APPLICANT NAME:
APPLICANT ADDRESS: Q / 9 2..
A!--; / /5 S1`
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Jc / ✓ /ZOO/-r
OWNER MAILING ADDRESS: 5-5- ,3,1
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ot994 - le Sd
TAX MAP NO. : Section 1/3 Block c Lot / ?—
CROSS
CROSS STREET: ety S' -0..¢Gpe
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Ap r1 cant
RECEIVED BY: /
Town Clerk's Office
DATE: L77/c. � / 9
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