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ELIZABETH A.NEVILLE y Town Hall, 53095 Main Road
TOWN CLERK c < P.O. Box 1179
t N Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS rri'I Fax (516) 765-1823
MARRIAGE OFFICER Z
RECORDS MANAGEMENT OFFICER y O� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 191 * *too
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2031 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
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 CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner THOMPSON, ROBERT & JEAN
Mailing Address 1 PO BOX 309
City St Zip SOUTHOLD NY 11971
Property Address 1 3600 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 75.00 block 8 lot 3.001
Cross Street
Building Permit Number Cross Reference:
Issue Date: 3/10/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
C3 /
FFOo-�o
ELIZABETH A.NEVILLE t‘ Town Hall, 53095 Main Road
TOWN CLERK . , P.O. Box 1179
N = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �' Fax (516) 765-1823
RECORDS MARRIAGE OFFICER AGEMENT OFFICER y Telephone (516) 765-1800
FREEDOM OF INF INFORMATION OFFICER
��. * ,t" P
OFFICE OFATHEgTOWN CLERK
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 4, 1999
Transmitted herewith is a copy of application No. 2111 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for robert and Jean Thompson .
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.
natur
3/ /
Date
OFFICE OF THE TOWN CLERK v,/'//•••••••,��•
TOWN OF SOUTHOLD .CJ�����K�QG Application No. , 1 I
Fr-r7ABETH A.NEVILLE,TOWN CLERK
44°
P.O.BOX 1179 _ Z Construction
SOUTHOLD,NEW YORK 11971
Alteration
,
$10.00 -Residential
Telephone *o. NItsb
(516) 765-1801 1 ,o'� $25.00 -Non-Residential Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION eaCE1VED
for MAR 4 1999
CONSTRUCTION or ALTERATION PERMIT *awthold Town Clikrit
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE 492-4/r,
APPLICANT NAME: "le',220
APPLICANT ADDRESS: ,qd 912-
-Tri Tv e%, AV 119-s a
SEPTIC CESSPOOL 1/
DESCRIPTION OF PROPOSED CONSTRUCTION OR • LTERATION
-, , , , i
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERAT N:
OWNER OF PROPERTY: a•'\7:e
OWNER MAILING ADDRESS: / 'Q /3,26
OWNER PROPERTY ADDRESS: 06,2)
TELEPHONE NUMBER OF CONTACT PERSON: 6141"--9&fre
TAX MAP NO. : Section Block ES"-- Lot 3' i f
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of A icant
' RECEIVED BY:
Town Clerk's Office
DATE:
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