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JUDITH T. TERRY ` . Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS : Southold, New York 11971
MARRIAGE OFFICER *0Fax 7"-•••
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Telephone (516)57651801'0[ + 7
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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. 790 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 AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10'0 SEPARATION AND CALL FOR INSPECTION.
Name Of Owner BUFK INS, DOUGLAS
Mailing Address 1 595 TUCKERS LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 595 TUCKERS LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 11 lot 4.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 1/07/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
VIA
JUDITH T. TERRY ".1. Town Hall, 53095 Main Road
,
TOWN CLERK P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS T i Southold, New York 11971
MARRIAGE OFFICER y �`� Fax (516) 765-1823
_��,yo *6 40.-��� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK MOVED
TOWN OF SOUTHOLD
December 27, 1991 JAN 02 Pc)
Town CIO Boothbid
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A811 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Douglas Bufkins
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 - X
DISAPPROVE -
COMMENTS: 6Q6 01-0 „gLu " CcOUbgiataNs
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OFFICE OF THE TOWN CLERK C,�,,,'"'" t�
Town of Southold .'' fUti( /
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Judith T. Terry, Town Clerk � � Application No. al,
Town Hall, 53095 Main Road � - = Construction l�
P. O. Box 1179 v ` T
Southold, New York 11971 Alteration
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Telephone 4. a �Q�i� $10.00 - Residential r/
(516) 765-1801 =y1 l , ' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE tk17)7/C)I
APPLICANT NAME:
APPLICANT ADDRESS: /"`'o *4 9�Z—
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:
OWNER MAILING ADDRESS 95"
OWNER PROPERTY ADDRESS: a-------
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section QSy. Block /J r tf17Lot ON/ ., 0 0 0
CROSS STREET: - �%
BUILDING PERMIT NUMBER CROSS REFERENCE:
Jig-
Signat e of Applicant
RECEIVED BY:
Riimilerk's Office
DATE:
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