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ELIZABETH A. NEVILLE ts y� Town Hall, 53095 Main Road
TOWN CLERK - P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS W 1�
`F Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER __ el */4; Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ i,"
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2278 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 LECREA, RENE
Mailing Address 1 PO BOX 158
City St Zip CUTCHOGUE NY 11935
Property Address 1 8525 BAY AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 3 lot 13.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 3/24/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �•1`t` �y�,`% Town Hall, 53095 Main Road
c '� P.O. Box 1179
TOWN CLERK %
yZ t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1
MARRIAGE OFFICER
O *- I Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER `‘4* ap0'1�1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER = ''' '�'��
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 22, 2000
Transmitted herewith is a copy of application No. 2366 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peronir Cesspool for Rene_I eCren •
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 follow'ng recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Date
OFFICE OF THE TOWN CLERK 1!',,,,,,..,.,,,��;CAFFOL/(QQi
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TOWN OF SOUTHOLD G: Application No. \p4
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 ; _ . Construction
SOUTHOLD,NEW YORK 11971 T ,
Alteration
trsTelephone �°,j� t�� $10.00 - Residential (/
(516) 765-1801 y011 � JO $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
APPLICATION MAR 2 2 20(0
for Soothoid Town Clerk
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 3// 7J/A-1)
APPLICANT NAME: � Z
APPLICANT ADDRESS: w /�� 7Z
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU TION OR LTER TION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: /042 , /Sr
OWNER PROPERTY ADDRESS: &S.2-5
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /0y' Block 3 Lot 13
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
4‘e4e-4 ,
Signature of A lice
5 pp
RECEIVED BY:
Town Clerk's Office
DATE:
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