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JUDITH T. TERRY Town Hall, 53095 Main Road
o ac P.O. Box 1179
REGISTRAR OF VITALTOWN CLEL TATISTICS ;tin ��� Southold, New York 11971
MARRIAGE OFFICER yQ �� Fax (516) 765-1823
���°1� Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 995 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. KEEP 10' SEPARATION. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner DEAN, ROBERT
Mailing Address 1 2275 DEEPHOLE DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 2275 DEEPHOLE DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 14 lot 14.000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/13/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY • •: Town Hall, 53095 Main Road
TOWN CLERK •
T P.O. Box 1179
REGISTRAR OF VITAL STATISTICSifs Southold, New York 11971
MARRIAGE OFFICER ‘%)10,0266 �Ot'
� Fax (516) 765-1823
��� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD MAY ! Q 1994'
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 10, 1993
Transmitted herewith is a copy of application No. A1023 for a Cesspool/
Septic Tank Construction Permit submitted by:
Pernnir Cesspool for Robert Dean •
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: AY la tflpi.--01-Pt"----
MA'AMM PECTMN / ,
REQUIRED •. •L/Ir
Signatur
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Dated 1 i
r' s
OFFICE OF THE TOWN CLERK %
Town
SWFUL,
Judith oSouthold
Clerk ��
� � Application No. �D a`Z-
< ;
Town Hall, 53095 Main RoadConstruction
P. 0. Box 1179
p *./ Alteration
Southold, New York 11971 �
Telephone Ol ' -
�' Residential i.p
(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 $ / 0 —
DATE 5/7M
APPLICANT NAME: ,
APPLICANT ADDRESS: P(, 4-ex'?7z.
-2-izziLAfE7/..e,c,X 2,
y 1/9cz
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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/1-74,- .4k.a, s
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A--oe--4..-it- &e-i---/-..
OWNER MAILING ADDRESS: 022 7s- 4.4.,--,X,..4 dt. .
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: .29,e-- S8
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TAX MAP NO. : Section //56.. Block / 9 Lot /Y•
CROSS STREET: .04144,1 ,S d
BUILDING PERMIT NUMBER CROSS REFERENCE:
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ge---X1-1.---e:_ 471W
Signature of Applica
RECEIVED BY: /Vt
_ Tow
Clerk's Office
DATE: l f�
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