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ELIZABETH A.NEVII.LE 10� yc ; Town Hall, 53095 Main Road
TOWN CLERK ti 2 P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘
. '�'* Ov�� Fax(516) 765-1823
MARRIAGE OFFICER Q( '0001 Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER c °�
FREEDOM OF INFORMATION OFFICER '��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1923 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
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 ANDERER, LAWRENCE J.
Mailing Address 1 22 BENNETT STREET
City St Zip ROCKVILLE CENTRE NY 11570
Property Address 1 950 STROHSON ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 10 lot 24.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 9/10/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE =`1® �Gy Town Hall, 53095 Main Road
TOWN CLERK p .�� P.O. Box 1179
Cl) Z % Southold, New York 11971
REGISTRAR OF VITAL STATISTICS p �'�t Fax (516) 765-1823
MARRIAGE OFFICER * �O 1 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER '(4 .j
FREEDOM OF INFORMATION OFFICER �•'o IP �1��iss�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: August 28, 1998
Transmitted herewith is a copy of application No. 2000 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Lawrence Anderer .
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.
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Date
)FFICE OF THE TOWN CLERK
Town of Southold ,..11400t1(14.;--_,.....
Judith T. Terry, Town Clerk ��' ,
, Application N
Town Hall, 53095 Main Road � • Construction
P. 0. Box 1179 -Mi; Alteration
Southold, New York 11971 . VI W ; ---____.
Telephone •=0O,j�O ���,�' $10.00 - Residential l' '
(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 I'
is
•
Permit No.
-
Fee $ `
DATE _ _ ��� -----____________ .
t
APPLICANT NAME: �j� / , /
• APPLICANT ADDRESS:—__,?-'a _ _—______-___-
--7-1e-&-
____ —
SEPTIC CESSPOOL `
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DESCRIPTION OF PROPOSED CONSTRUC ION OR ALTERATIOItJ _ _�
/,
LOCATION MAP: Must be attached hereto before permit may be issued.
•
LOCATION CPROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY :
OWNER MAILING ADDRESS: 2. � �_'1, 'r
OWNER PROPERTY ADDRESS: ?5-00 ____S'7.414i .-_ _-_---
...0-e-e-45A4--Se_
TELEPHONE NUMBER Cr CONTACT PERSON:
TAX MAP NO. : Section /f Block / 0 Lot .
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
61- // ,
Signature • Applicant
RECEIVED B Y: RECEIVED ,,, • ,. .,,i,
Town C erk's Of ice
I
DATE: AU 6 2 8 1998
Southold Town Clerk /_ 41
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