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ELIZABETH A. NEVILLE ��_ 'yd• Town Hall, 53095 Main Road
TOWN CLERK ` o P.O. Box 1179
H
v, � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � Fax(631) 765-6145
MARRIAGE OFFICER : ' ! ,1
RECORDS MANAGEMENT OFFICER = "'/Ql a� ,� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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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. 2251 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 KELLEHEN, DANIEL
Mailing Address 1 996 PIKE STREET
City St Zip MATTITUCK NY 11952
Property Address 1 996 PIKE STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 2 lot 25.000
Cross Street WICKHAM AVENUE
Building Permit Number Cross Reference:
Issue Date: 3/01/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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a G Town Hall, 53095 Main Road
ELIZABETH A. NEVILLE 'y
TOWN CLERK S_.', 1,,-) l5 i -'4 , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS I v. 1 Southold, New York 11971
MARRIAGE OFFICER FEB 2 �`O . Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER _ 0 ��0oi 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 : February 24, 2000
Transmitted herewith is a copy of application No. 2340 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Daneil Kelleher
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.
i
Signa e
-/ )- ' Lo 6
Date
OFFICE OF THE TOWN CJ,ERK . ,�'CAFFOUre - ,5(Z/ I
TOWN OF SOUTHOLD � Q n(•QG'' Application No. ���///
ELIZABETH A.NEVILLE,TOWN CLERK �. -?,4.\
P.O.BOX 1179 ; Construction
SOUTHOLD,NEW YORK 11971 .Z
^' Alteration
Telephone =�0V Qre • $10.00 - Residential
(516) 765-1801 '. 1 ��'�,
- � �� $25.00 -Non-Residential
•TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE yZ3/,--/
APPLICANT NAME: ) Lr,'? eri 4 ,, ,
APPLICANT ADDRESS: A? 4
SEPTIC CESSPOOL tl
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A ,,6
OWNER MAILING ADDRESS: 7) /Z4.
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: Oft-lo,,S
TAX MAP NO. : Section / L Block 2- Lot 4 5
CROSS STREET: G'2 --i6 .,__ .,_.
BUILDING PERMIT NUMBER CROSS REFERENCE:
/4,-- y
4 tE C E 1 V E IR Signatur f Applicant
RECEIVED BY: FEB 2 4 2000
Town Clerk's Office
DATE: )Quthold 1 own Clerk
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