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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK p ryaP.O. Box 1 179
REGISTRAR OF VITAL STATISTICS • Q Southold, New York 11971
MARRIAGE OFFICER z.yQ Fax (516) 765-1823
��� �� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1019 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
INSTALLATION OF NEW TYPE CESSPOOL TO REPLACE EXISTING CESSPOOL.
APPROVED AS SUBMITTED. KEEP 10' APART. EXCAVATION INSPECTION REQUIRED
Name Of Owner FAHEY, PHILIP
Mailing Address 1 440 ROCHELLE PLACE
City St Zip MATTITUCK NY 11952
Property Address 1 440 ROCHELLE PLACE
City St Zip MATTITUCK NY 11952
Tax Map No. section 144.00 block 5 lot 24.000
Cross Street SALT LAKE LANE
Building Permit Number Cross Reference:
Issue Date: 7/08/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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,h ,4, 4 Town Hall, 53095 Main Road
JUDITH T.
TOWN CL: ' ' :LDG, DEPT. : v P.O. Box 1179
REGISTRAR OF VITA STA ' I OF SOUTHOLD �` Southold, New York 11971
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MARRIAGE 0 V �- �tFax (516) 765-1823
oro, s its Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 28, 1993
Transmitted herewith is a copy of application No. A1048 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Philip Fahey .
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.
jIL.'Q
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
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COMMENTS: —at—i' ,, / fes/
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EXAVATIoN
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JUL 8 Signature
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OFFICE OFt THEITOWN CLERK ����,,,'",,,,,
Town of Southold �FfNir _ C`
Town Clerk �' �� CSG - Application No. /G T 8
Judith T. Terry, �, y'
Town Hall, 53095 Main Road ;r° Construction
P. O. Box 1179 ; a .2m ;
Alteration
Southold, New York 11971 s Ifs
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Tele hone `---_!#_ 0
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y0 $10.00 - Residential 1./
(516) 7p65-1801 _0 -0„.'
$25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT -- .- .-...s. ,,,-40.
RECEIVED
APPLICATION JUN 28 1993
for
Southold Town Clerk
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE C/ 175
APPLICANT NAME: / 4-)i .
APPLICANT ADDRESSAO 4ry97z-
SEPTIC CESSPOOL
DESCRIPTIONF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION
� OQR ALTERATION:
OWNER OF PROPERTY: hat /4 4 / •
OWNER MAILING ADDRESS: -4/4 -0 i? i //_e_ / •
OWNER PROPERTY ADDRESS: •
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / (Pi Block S Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signat re of Appl nt
RECEIVED BY :� .1 -
To Clerk's Office
DATE: 6 "cq-q,3
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