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u' � Town Hall, 53095 Main Road
�� P.O. Box 1179
* Southold, New York 11971
JUDITH T. TERRY _�-,,,, /100t,II TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 485 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 SYSTEM WITH NEW TYPE OF SEPTIC AND OVERFLOW.
APPROVED AS SUBMITTED. CALL FOR INSPECTION AFTER EXCAVATION.
Name Of Owner HADDINK, JOHN
Mailing Address 1 614 BAILEY AVENUE
City St Zip GREENPORT NY 11944
Property Address 1 614 BAILEY AVENUE
City St Zip GREENPORT NY 11944
Tax Map No. section 34.00 block 4 lot 5.000
Cross Street NORTH ROAD
Building Permit Number Cross Reference: •
Issue Date: 4118189 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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BLDG DEPT • `''t'� ':ztt ,,ir , , Town Hall, 53095 Main Roar
TOWN OF�p . O, ��` �".` �� ,
� ;'1 ...<;r�•• P.O. Box 1179
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Southold, New York 11971
,JUDITH T. TERRY
4.�'"� ��/��/ TELEPHONE
TOWN CLERK
(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
April 12, 1989
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A496 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for John Haddink
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 - X
DISAPPROVE -
COMMENTS: a �` CP.
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Signature
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' P19FFICE OF THE TOWN CLERK c312.U'`+"
Town of Southold � Application
Judith T. Terry, Town Clerk
Town Hall 53095 Main Road '
Construction
P. O. Box 1179
Alteration /s
Southold, New York 11971 0
Telephone ®1 Nt Residential
(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE c-eA'! ®2/(J
APPLICANT NAME: /-4 2--�,,9 / ,./4/ /7/61., A
APPLICANT ADDRESS: /� Y
SEPTIC kJ CESSPOOL)
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU TION OR ALTERATION:
OWNER OF PROPERTY: �A4V / nClGI,//iu/r
OWNER MAILING ADDRESS: 6/ L ////e ,Ute
41/24
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 27f,- 76 5-Cc-
TAX MAP NO. : Section 3 Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE: •
Signature of Ape icant
RECEIVED BY: !� ez.„49
[ o` 'r erk's 0 ice
DATE:
APR 12 NH
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