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JUDITH T. TERRY • yL Town Hall, 53095 Main Road
TOWN CLERK v T •
• P.O. Box 1179
CP �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO Fax 0° Fax Fax (516) 765-1823
MARRIAGE OFFICER .%, • Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '.'t/ 4iore.
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1235 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
REPLACE EXISTING CESSPOOL WITH NEW TYPE.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner MCCALL, ADRIAN
Mailing Address 1 P. O. BOX 271
City St Zip CUTCHOGUE NY 11935
Property Address 1 10230 NEW SUFFOLK AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 116.00 block 6 lot 3.000
Cross Street MOORES LANE
Building Permit Number Cross Reference:
Issue Date: 10/27/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY � = z Town Hall, 53095 Main Road
TOWN CLERK . p rT P.O. Box 1179
cls w � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO ,' Fax (516) 765-1823
MARRIAGE OFFICER _ ��jj�� .a� �.' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER `'��/1 �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 l 4 1994
DATED: October 21, 1994 _
Transmitted herewith is a copy of application No. A1280 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Adrian McCall .
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 - EXCAVATION INSPECTION
DISAPPROVE - REQUIRED
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature !
/6/06—
Date
aDate /71..
r
OFFICE OF THE TOWN CLERK 1� ,,''' '''--
Town of Southold �� olK`+-y
0 Application No./
Judith T. Terry, Town Clerk +
Town Hall, 53095 Main Road L ; Construction Ar--,
P. O. Box 1179 o am
Southold, New York 11971 us W$ Alteration
Telephone O,l �Q �� $10.00 - Residential
(516) 765-1801 = Ol 11 ,, ' $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 /OA/ '✓
APPLICANT NAME:_frie2fiz,
-
APPLICANT ADDRESS: /� Air 97 —
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
,_ ,i...ii.. .� �.r
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU TION OR ALTERATION
OWNER OF PROPERTY: gibie/,9/4' /4Z t ��
OWNER MAILING ADDRESS: A D ?7/
OWNER PROPERTY ADDRESS: /40 2- ay NArit S
' � I/r3s'
TELEPHONE NUMBER OF CONTACT PERSON: did - 9�o,ft
TAX MAP NO. : Section //( Block Lot 3
CRS-STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature • Ap licant
RECEIVED BY:
Tc.vn Clerk's Office
DATE:
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