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ELIZABETH A.NEVILLEayL , Town Hall, 53095 Main Road
TOWN CLERK o _ P.O. Box 1179
y Southold, New York 11971
REGISTRAR OF VITAL STATISTICS vo Fax (516) 765-1823
MARRIAGE OFFICER 1i `.
RECORDS MANAGEMENT OFFICER �0 �aO �� Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,i �����
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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. 1931 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 PETER WICKHAM
Mailing Address 1 3854 TRAIL RIDGE, SE
City St Zip CEDAR RAPIDS 10 52403
Property Address 1 OLD HARBOR ROAD
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 3 lot 1 .000
Cross Street NEW SUFFOLK ROAD
Building Permit Number Cross Reference:
Issue Date: 9/24/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OFFICE 0'F THE TOWN CLERK """"'--• � )
Town of Southold ��'''�OfIlLk 0 Application No.02, (/
Judith T. Terry, Town Clerk ��' �� Gy
Town Hall, 53095 Main Road z•. a• Construction 1i
P. 0. Box 1179 , o, ,-„ ;
i Alteration
Southold, New York 11971
10.00 - Residential
Telephone _�' il $(516) 765-1801 0l * , $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 7/54CF
APPLICANT NAME:
f` - &.e. 900-fr(
APPLICANT ADDRESS: ",D /66r7e 97Z-
7114 A' /7 fSZ-
SEP•i CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
c
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSCTION ��E TION:
OWNER OF PROPERTY: -E�
OWNER MAILING ADDRESS: ft31S.44 /ii' S 0
eezikt /1 .7"lor tra_ sL 5423
OWNER PROPERTY ADDRESS:
e/d,#zL-L , / '''t4- 4e')
TELEPHONE NUMBER OF CONTACT PERSON:"' ' 9F 74.
50
TAX MAP NO. : Section // 7 Block 3 Lot /
CROSS STREET: 40 /1/,01/Y•s#1,( 4-0e '
BUILDING PERMIT NUMBER CROSS REFERENCE:
‘406....t.4 L' A?),-,
Signature of plicant
RECEIVED
RECEIVED BY:
Town Chip'3 Cpl
DATE: -
Southold Town Clerk
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