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ELIZABETH A. NEVILLE �_� Town Hall, 53095 Main Road
TOWN CLERK y -
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P.O. Box 1179
4cf. Pryi Southold, New York 11971
REGISTRAR OF VITAL STATISTICS11
MARRIAGE OFFICER %` �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER
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FREEDOM OF INFORMATION OFFICER ''•1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2432 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner PIACENTE, KEITH
Mailing Address 1 4375 MILL LANE
City St Zip MATTITUCK NY 11952
Property Address 1 6130 NEW SUFFOLK AVENUE
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 2 lot 17.005
Cross Street GEORGE ROAD
Building Permit Number Cross Reference:
Issue Date: 10/13/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ��a t Town Hall, 53095 Main Road
TOWN CLERK o -
H P.O. Box 1179
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v, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Q V S Fax (631) 765-6145
MARRIAGE OFFICER V 4, �S
RECORDS MANAGEMENT OFFICER l a�'i� Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 6, 2000
Transmitted herewith is a copy of application No. 2512 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Keith Piacente
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Date
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OFFICE OF THE TOWN CLERK
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Town of Southold 0' tfaires %
Application
judith T. Terry, Town Clerk ... c3.,,,••••, „,,s0, ...
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Town Hall, 53095 Main Road :
, .. ; Construction
P. 0. Box 1179 , : fif 1
Alteration
Southold, New York 11971 - '‘:711 $t ue, sin , rio Residential
Telephone ,....... ,,,
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;25. 00 Non Residential
(516) 765-1801 _.
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TOWN or SOUTHOLD
SOUTHOLD WASTEWATER DISPOS .‘1.. DISTRICT
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APPLICATION
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CONSTRUCTION or AL1 IRA r !ON PERMIT
SEPTIC TANi< or cusspooL
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Permit No. ,
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Pee $ _____ -
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APPLICANT NAME: ____ __, _ ____ __.......0e-If_. _ _ ii _ ___ _ _ _ _ _______ __ _ _ _ _ _
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. APPLICANT ADDRESS: fee2., d P'7 2, 4-
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SEPTIC CESSPOOL __ /....-- *
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DESCRIPTION OF: PROPOSED CONSTRt'CTION OrZ. ALTERATION _ 1
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LOCATION MAP- Must be attached hereto before permit rt,ay be issued
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LOCATION OF PROPOSED CONSTRUC1 P)N OR A .T RATION: 1 _
OWNER OF PROPERTY : A---___41.0r0C____ _ .‹......‹...,_rsao .'..--
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OWNER MAILING ADDRESS: 9_32,,r_____Alete& ,„&„..,,s—gi ;
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OWNER PROPERTY ADDRESS: _ 4.,/,3_& /t/Z•w S-1;(041.4 d//04-.A.1
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TELEPHONE NUMBER OF CONTACT PERSON: 497R".....94, 5r _ -1,
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TAX MAP NO. . Section_.../ , 7 ______ ,Block 0.. Lot / 7 5 E
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CrRQ.S.S STREET : ,_4.elieks_41.,....__ or,„”
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BUILDING PERMIT NUMBER CROSS REFERF 4ICE:
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