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ELIZABETH A. NEVILLE I
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Gym; Town Hall, 53095 Main Road
TOWN CLERK ; Cl) P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Z Southold, New York 11971
MARRIAGE OFFICER 1 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER '.y5a��'��� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER : ' 'l '���d
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2147 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P.O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
REPLACE CAVED IN OVERFLOW WITH NEW TYPE OF CESSPOOL.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner MORTON, ROSALIE & CONNELLY, D.
Mailing Address 1 535 ELIJAH LANE
City St Zip MATTITUCK NY 11952
Property Address 1 535 ELIJAH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 108.00 block 4 lot 12.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 9/08/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ��h'Z` yam►` •wn Hal 095 Main Road
TOWN CLERK P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS W %
MARRIAGE OFFICER Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER Vv4na0�11�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER c 1 * *0.1
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 7, 1999
Transmitted herewith is a copy of application No. 2233 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Cesspool for Rosalie Morton/Dorothy Connelly .
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following re mmendations:
APPROVE
DISAPPROVE
Comments:
./CtSignat 01114
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Dated
OFFICE OF THE"[OWN l'l,l:Kli §\��QCY nAw_
TOWNOFSOL TH(r1.11 �J ,1 G•�J`` Application No.Q4
ELl7ABEIll A NEVII.li !OiWNtLI 7/►�
PO BOX II'v >~ G Construction
SOLTHOU).`lFV.YORK , .r:zo • ;
cn Alteration y C'
TeleF)h;:ne �d�i� $10 .00 Residential
(516) ,
, . ,,1 =_ l + � �' $25 .00 Non- Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPO ;AL DISTRICT
APPLICATION t'3
L'.
for
CONSTRUCTION or ALTERAT ON PERMIT
SEPTIC TANK or CESS 'OOL
Permit No.
Fee
DATE: /7//f _.
APPLICANT NAME .
APPLICANT ADDRESS. 772
'-.777A7
7�
SEPTIC CESSPOOL •
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DESCRIPTION OF PROPOSED CONSTRUCT ION OR ALTERA1 ION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUC TIN. OR Ai TERATION :
OWNER OF PROPERTY : � � .�--� 4(4.4
OWNER MAILING ADDRESS ,S"" _ e 1.
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON 19e--- G Y"8'
TAX MAP NO. : Section (' (k' Block eiLot 2_
C STREET
BUILDING PERMIT NUMBER CROSS REFERENCE :
Signature of A icant
RECEIVED BY : /
'17/963
Town Clerk's ffice
DATE:
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