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ELIZABETH A. NEVILLE /h� t Town Hall, 53095 Main Road
TOWN CLERK • o P.O. Box 1179
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tSouthold, New York 11971
REGISTRAR OF VITAL STATISTICS ; G yC �� Fax (631) 765-6145
MARRIAGE OFFICER 4,/� II
RECORDS MANAGEMENT OFFICER �__4to *a�'ii Telephone (631) 765-1800
jig FREEDOM OF INFORMATION OFFICER ,i��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2289 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 FLYNN, ADELAIDE
Mailing Address 1 PO BOX 815
City St Zip SOUTHOLD NY 11971
Property Address 1 5270 MAIN BAYV I EW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 4 lot 33.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 4/14/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE t�_� y� Town Hall, 53095 Main Road
TOWN CLERK C - P.O. Box 1179
Pr/ �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
G `F 1 Fax(631) 765-6145
MARRIAGE OFFICER
RECORDSMANAGEMENT OFFICER d6Ol * .���0� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER . 0,18rI�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 4, 2000
Transmitted herewith is a copy of application No. 2377 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Adelaide Flynn
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.
4444a:
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
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD �t" � Application No. OZ 3 77
FLI7ABETH A.NEVILLE,TOWN CLERK ---
P.O.BOX1179 ; Construction ,L
SOUTHOLD,NEW YORK 11971 0 .T
Alteration
Tele hone Oil' $10.00 - Residential
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(516) 765-1801 01 4t ,,�'� $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 3/30/0
APPLICANT NAME: ,
APPLICANT ADDRESS: oto, P7Z
SEPTIC CESSPOOL _—
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 4-06-Z,04/40,- Airlf/A/
OWNER MAILING ADDRESS: 110, 2/r
SovIltdfq'
OWNER PROPERTY ADDRESS: 6270 /110..;.A.
TELEPHONE NUMBER OF CONTACT PERSON: clre. 999s-Er
TAX MAP NO. : Section le Block 44- Lot 33
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVF
Signature Applicant
APR — 4 2tn.
RECEIVED BY:
Southold 1Toown(Clerk's Office
DATE:
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