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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK rZ P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS to Southold, New York 11971
MARRIAGE OFFICER ;���� ��������� Tel23
SoutFax (516)6) 5768-1801
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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. 918 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
REPLACE EXISTING CESSPOOL WITH NEW TYPE.
APPROVED AS SUBMITTED. REMOVE EXISTING POOL AND DEPOSIT AT LANDFILL.
CALL FOR EXCAVATION INSPECTION.
Name Of Owner DELFAUSSE, LYNNE
Mailing Address 1 1355 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 1355 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 11 lot 27.000
Cross Street OLE JULE LANE
Building Permit Number Cross Reference:
Issue Date: 10/14/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL 1
Ia.�� F o1KoG
% yL Town Hall, 53095 Main Road
JUDITH T. TERRY •
Z ' P.O. Box 1179
TOWN CLERK G T
tr2Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � � �` Fax (516) 765-1823
MARRIAGE OFFICER ,�� Telephone (516) 765-1801
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SEP 2 91992 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 29, 1992
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A940 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Richard Griffith
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. aft-e -r-1 _
c
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE ,S
DISAPPROVE - nn p
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OFFICE OF THE TOWN CLERK ,'''''',,""
Town of Southold '�.''1.�� 111.k ' = Application No. ? 7
Judith T. Terry, Town Clerk '• Gy
Town Hall, 53095 Main Road ; enim Construction �-i'/
P. 0. Box 1179 � � rn1
Southold, New York 11971 t.c=8 '�, Alteration
Tele hone Q ��' $10.00 - Residential "
(516) 765-1801 --- ��
- � '' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 9 zi/6
Fee $ /e
DATE 0r ?Z
APPLICANT NAME: /...ee---01..e...-z, 64e.-475.....6)---6"--
APPLICANT ADDRESS: AZ) ri ,Y t
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERA •N:
OWNER OF PROPERTY: ,. /,/ /
OWNER MAILING ADDRESS:/97, �Z.� 7 3<„.
ADDRESS:/9-7.- -Ce... '
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT7PERSON:
TAX MAP NO. : Section /1743 Block / Lot 2-,
CROSS STREET: _. .t 4=r ` k%1
BUILDING PERMIT NUMBER CROSS REFERENCE:
/ /Aare
Signature of Applican
RECEIVED BY: AL /1-0kA-----e,<-C,
nn,, Town Clerk's Office
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DATE: ,./r//ct._
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