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ELIZABETH A. NEVILLE �� 'yd; Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
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�y n� Southold, New York 11971
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REGISTRAOF VITAL STATISTICS � Fax(631) 765-6145
MARRIAGE OFFICER �Oy
RECORDS MANAGEMENT OFFICER � Q *s'O eee1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �1�s
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OFFICEOFTTQFHEppTOWHppNLLpCLERK
SOUTHOLD WAS�fEVIrATERUDISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2390 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 WHEELER, WARREN C
Mailing Address 1 PO BOX 501
City St Zip MATTITUCK NY 11952
Property Address 1 1240 MASTERS ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 126.00 block 4 lot 11 .001
Cross Street PECONIC BAY BLVD
Building Permit Number Cross Reference:
Issue Date: 8/24/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
low
11 AUG I . U.)r_ G.DEPT �,o'„OFFO(4'
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TOWN OF SOUTHOLD ,r O0 0
ELIZABETH A. NEVILLE �� _ 1 : Town Hall, 53095 Main Road
TOWN CLERK % c - P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v'
Fax (631) 765-6145
MARRIAGE OFFICER y �I
RECORDS MANAGEMENT OFFICER -'/Ql �a� � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ,a'
,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: August 17, 2000
Transmitted herewith is a copy of application No. 2480 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Warren C. Wheeler
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.
Lin� erCoo
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 ad'acgat w U
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
ignature
, / u
Date
OUWLU111U rCRIVII 1 IYUIVIOCR ♦.RUJJ RC1-cr•cr LC:
1! •
Signature of Appl j-nt
RECEIVED BY:
own Clerk's Office
DATE: Ft/ .7/Z3`
4
OFFICE OF THE TOWN CLERK �',C,AMILir - / O `'
TOWN OF SOUTHOLD �' Ql/= • Application No.
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 : Construction
SOUTHOLD,NEW YORK 11971 • /
Alteration s/
• . $10.00 -Residential
Telephone %-..f4:00,
�.� �0�,,•� �
(631) 765-1800 -=�1 0:•0 $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE X//5/ ert)
APPLICANT NAME: (731-ge-71?-wt—d
APPLICANT ADDRESS: i; e "3l Z
(-)--44 /U /m5-2..._
SEPTIC CESSPOOL 1/'
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
d�
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: e,
OWNER MAILING ADDRESS: /?I /2i 50 /
A/ (' //t 5-I--
OWNER
ZOWNER PROPERTY ADDRESS: /2— ��e •
11')attciki n L
TELEPHONE NUMBER OF CONTACT PERSON: 2 '--76SV
TAX MAP NO. : Section /Z• 1 Block Lot 14 /
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
K�G .
Signature of Appl nt
RECEIVED BY:
own Clerk's Office
DATE: �i .7/Z
! t Town Of Southold
•
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 08/17/00 Receipt#: 4965
Transaction(s): Subtotal
1 Septic Permit-Construct- Resid. $10.00
Check#: 4965 Total Paid: $10.00
Name: Peconic, Cesspool
126-4-11.1 P O Box 972
Mattituck, N Y 11952
Clerk ID: LINDAC Internal ID: 16746
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