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JUDITH T. TERRY � < ; Town Hall, 53095 Main Road
TOWN CLERK : p rZ P.O. Box 1179
Ul'1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = �� �. �� Fax (516) 765-1823
MARRIAGE OFFICER -Mtn A, , Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ' �/ *
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. 1062 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 SYSTEM WITH NEW TYPE OF CESSPOOL.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner MCDONALD, RICHARD J.
Mailing Address 1 7-A JAYNE AVENUE
City St Zip MELVILLE NY 11747
Property Address 1 CALVES NECK ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 63.00 block 7 lot 29.001
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 11/30/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK G T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS =
SOuFax ( New York 11971
MARRIAGE OFFICER yQ O�' Fax (516) 765-1823
l �1D 'is Telephone (516) 765-1801
r.Jilt .
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
NOV - 9
TO: Southold Town Building Department •
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 9, 1993
•
Transmitted herewith is a copy of application No. A1094 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Richard J. McDonald
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.
c i4 J
Linda J. Cooper
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DOCAVATIJ74 iNSpEcnON
DISAPPROVE - I QQUI�COMMENTS: e44,
REQUIRED
ROMNay sw. lo42- /. „ 7
Sinate
TM! CINIC9
9/0/
Date
OFFICE OF THE TOWN CLERK ,,,•"•,
Town of Southold Application No�/e Q!!//
Judith T. Terry, Town Clerk �' � G�
Town Hall, 53095 Main Road _ C. • ion
P. O. Box 1179 v IT
Southold, New York 11971 sits *.$ Alteration
Telephone O �� � $10.00 - ' esidentiai r/
(516) 65-1801 'y01
,, ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE f l fB
/3
APPLICANT NAME: del. C�
APPLICANT ADDRESS: Odie 4r / 7 7
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION ,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Ai G •
OWNER MAILING ADDRESS: 7 ,
• l`7`/1
OWNER PROPERTY ADDRESS: Li-cl / 714CI
s er-u.zrada
TELEPHONE NUMBER OF CONTACT PERSON: (9-0,- fp
TAX MAP NO. : Section t 3 Block c & ^7 Lot 9,C c `�, /
CROSS STREET: ! 2'r ...
BUILDING PERMIT NUMBER CROSS REFERENCE:
ofe-'4.4 -1/4"-ja
• Signature of Appint
RECEIVED BY: /6`i / _
jj To n Clerk's Office
DATE: ////97 -
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