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ELIZABETH A.NEVILLE .ZO l/y� Town Hall, 53095 Main Road
TOWN CLERK %� c -� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Z Southold,New York 11971
MARRIAGE OFFICER Fax/ Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER - I 4W- �� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER =��1 4. -0.010
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1978 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 EXISTING POOL WITH NEW TYPE.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner KENNEY, MRS. RAYMOND J.
Mailing Address 1 3655 STILLWATER AVNEUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 3655 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 136.00 block 2 lot 11 .000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 12/15/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE y�\O CttZ Town Hall, 53095 Main Road
TOWN CLERK i c <r P.O. Box 1179
t ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER • Oy � Telephone hone (516) 765-1800
RECORDS MANAGEMENT OFFICER � ''49! �`� �
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FREEDOM OF INFORMATION OFFICER l '
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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: December LI, 1998
Transmitted herewith is a copy of application No. 2056 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Mrs. Raymond Kenney
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 followi recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Signa e
Date
•
OFFICE OF THE TOWN CLERK ,'�' �`F DLK
TOWNOFSOUTHOLD �J CQG Application No.oi/Co
ELIZABETH A.NEVII.I F,TOWN CLERK
P.O.BOX 1179 :}� !� Construction
SOUTHOLD,NEW YORK 11971 Z
• Alteration
`'O $10.00 -Residential ✓
Telephone '-__j� �����
(516) 765-1801 1 �,:'' $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 ii/67 /9f7
APPLICANT NAME: ff...0-e..-0-n;v-
APPLICANT
ADDRESS: /',y �)Z
SEPTIC CESSPOOL V
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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A•erZt -4440441
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: �j
OWNER MAILING ADDRESS:,36,55 S'y` GLµ 4
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 59 n Sp'
TAX MAP NO. : Section /3 Block 2- Lot //
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of pplicant
RECEIVED BY:
,ra-r
Town Jerk's Office BrCSIVED
DATE:
DEC 3 1999
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