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JUDITH T.TERRY �� #� Town Hall, 53095 Main Road
TOWN CLERK g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS V � Southold,New York 11971
MARRIAGE OFFICER V ei •
Fax 1Fax(516)765-1823
RECORDS MANAGEMENT OFFICER RI ED Telephone(516)765-1800
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. 1262 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 AN OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner HUEY, MICHAEL
Mailing Address 1 P. O. BOX 691
City St Zip MATTITUCK NY 11952
Property Address 1 BROWER ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 139.00 block 1 lot 7.000
Cross Street MAYFLOWER ROAD
Building Permit Number Cross Reference:
Issue Date: 12/16/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY % ® '' Town Hall,53095 Main Road
TOWN CLERK ` g , P.O.Box 1179
11, Southold,New York 11971
REGISTRAR OF VITAL STATISTICS '4,....:&• `� 1 Fax(516)765-1823
MARRIAGE OFFICER ,,,,,7%. ..,
� 11
RECORDS MANAGEMENT OFFICER --_764 0 Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER —....,.. ,i--' .
OFFICE OF THE TOWN CLERK if7:71717------'li
TOWN OF SOUTHOLD �,, il
E
TO: Southold Town Building Department P DEC — 9 1994 `� l
IJ i
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: December 8, 1994 TOWN BLDG.
Transmitted herewith is a copy of application No. A1308 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Michael Huey
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 - C/gr
3�y. `�� ���
_,GCAVATION 9NS?EC
DISAPPROVE - REWIRED
COMMENTS: Maintain required setbacks from adjacent wells,,., ., • •
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
RED ;�-�-
DEC/1 61994 Signature C/
lowCI�[k �a#lt0l� `g'/i" �/
Date
C'F IGE OP- I'E TOWN CLERK ,i"
�- '7 Town of Southold ��' � �FFD(K
Judith T. 'rrry, Town Clerk ��l/�; Application N.,.-"t30/
Town Hall, 53095 Main Road ; < : Construction •
P. 0. Box 11791
TAlteration
Southold, New York 11971 • V) .�
Telephone ,y Ar ' $10.00 - Residential C�
(516) 765-1801 Ol 4I, / $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/
APPLICANT NAME: ir-e-e--er2-14---C,
APPLICANT ADDRESS: /? 2 . 2C 97z
SEPTIC- CESSPOOL •
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION_______
77; f �l�� _ _
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTIQN OR ALTERAT • , :
OWNER OF PROPERTY:! l /
OWNER MAILING ADDRESS: 4e, s Q9/
OWNER PROPERTYADDRESS:
r r /
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Y Block / Lot
6 ' STREET: "9-C( //®
BUILDING PERMIT NUMBER CROSS REFERENCE:
-"--1--4'44g/C
4//r
Signature of Ap. !cant
RECEIVED BY:
Town Clerk's Office DATE:
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