HomeMy WebLinkAboutDohm, Helen M-1802
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Town Hall, 53095 Main Road
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P.O. Box 1179
`y- Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 410 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 NEW OVERFLOW CESSPOOL TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. DISTANCE BETWEEN THE POOLS ARE NOT TO EXCEED
151011.
Name Of Owner DOHNL HELEN
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Mailing Address 1 P. O. BOX 287
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City St Zip PECONIC NY 11958
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Property Address 1 330 SOUND AVENUE
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City St Zip PECONIC NY 11958
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Tax Map No. section 67.00 block 1 lot 6.000
Cross Street MILL ROAD
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Building Permit Number Cross Reference:
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Issue Date: 10/13/88 Judith T. Terry
-------- Southold Town Clerk
(TOWN SEAL)
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Town Hall, 53095 Main Roac
P.O. Box 117 9
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.TUDITH OFSOUTyOt_�� : 1 Southold, New York 11971
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TOWN CLERK TELEPHONE
REGISTRAR OF VITAL STATISTICS (516)765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
October S, 1988
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. 415 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
_Peconic Cesspool for Mrs. Helen Dohn
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
1 have reviewed the application and location ma of the =
above and make the following recommendation: p Project listed
APPROVE - k
DISAPPROVE -
COMMENTS:
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Signature
Dat_1�11'i.. ��
OFFICE OF THE TOWN CLERK
Town of Southold �� C Application No.—'rt-'--�' __.
Judith` T. Terry, Town Clerk ►�
Town Hall, 53095 Main Road Construction
P. O. Box 1179 Ul O�e � Alteration
Southold, New York 11971
Residential
Telephone
(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 $
DATE
APPLICANT NAME:
/_41-
APPLICANT ADDRESS: 97 Z-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION—!
40,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 74.t�_ _ z"
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OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 7 Block Lot
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CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signat re of Applic
RECEIVED BY:
Town Clerk's Office
DATE:
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