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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK H Z P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS
Southold,New York 11971
MARRIAGE OFFICER �y� o‘l0 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER 0.( * 1►a��l Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER '—. •0°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1308 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. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner DAWSON, MICHAEL
Mailing Address 1 P. O. BOX 1207
City St Zip SOUTHOLD NY 11971
Property Address 1 1735 BRIGANTINE DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 4 lot 59.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 4/07/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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OOO/# • �Gt : Town Hall, 53095 Main Road
JUDITH T. TERRY E►
TOWN CLERK p IZr P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO . Fax (516) 765-1823
MARRIAGE OFFICER �j� �O Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ."(i �I��.'�•'
FREEDOM OF INFORMATION OFFICER „i/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department ,
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 27, 1995 -
Transmitted herewith is a copy of application No. A1356 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Michael Dawson
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Signa ur-
Date ff///s'3
OFFICE OF THE TOWN CLERK """
Town of Southold four i3_ib
Judith T. Terry, Town Clerk ;' o CSG Application lido.
Town Hall, 53095 Main Road �� Construction ~---
P. O. Box 1179 _
Southold, New York 11971 �t�t� ; Alteration
Telephone ���i' $10.00 - Residential
(516) 765-1801 1
, '� �
$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 3 7/fr�
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APPLICANT NAME: 77-ee�'"7172e,--C,
APPLICANT ADDRESS: ,, e) �� `7 Z.-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
CVYG�LG 1 �/ -)Qe`.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION.
OWNER OF PROPERTY: A�
OWNER MAILING ADDRESS: F 4 i Z o 7
OWNER PROPERTY ADDRE$4735- /'-j_ .
TELEPHONE NUMBER OF CONTACT PERSON: a--,,k —1 , 5 d
TAX MAP NO. : Section ?? Block ...wrY Lot T. s--.?
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature A plicant
RECEIVED BY:
Town Clerk's Office
DATE:
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