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JUDITH T. TERRY , Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` Southold, New York 11971
MARRIAGE OFFICER
$41 Fax (516) 765-1823
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+ �1�®� 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. 1039 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
ADDITION OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQURIED DISTANCE FROM ADJACENT WELLS
AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner HUNTER, JAMES
Mailing Address 1 92 CORNELL DRIVE
City St Zip SMITHTOWN NY 0000
Property Address 1 1085 OLD SHIPYARD LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 64.00 block 5 lot 23.000
Cross Street HOBART ROAD
Building Permit Number Cross Reference:
Issue Date: 8/26/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
it ® `..
JUDITH T. TERRY Al Town Hall, 53095 Main Road
TOWN CLERK ` i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1� Southold, New York 11971
‘'s,/ �� Fax (516) 765-1823
MARRIAGE OFFICER ��'.�
®4!" Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK .
TOWN OF SOUTHOLD0 Ig — Ll 'r:1 i :_ "
•
TO: Southold Town Building Department 1 AUG 2
01993 , �r'�'
FROM: Linda Cooper, Southold Town Clerk's Office �, ;1!
DATED: August 20, 1993 d Ems;; - ?°
•
Transmitted herewith is a copy of application No. A1070 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for James Hunter .
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 - , EXCAVATION INSPECTION
DISAPPROVE - R I
RED
COMMENTS:
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Signa ur:
eV'-..)-5793
Date
OFFICE OF, THE TOWN CLERK ,'''" 'Town of Southold 0 6
Town Clerk �' � l/ Application No.(
Judith T. Terry, � �'
Town Hall, 53095 Main Road <; Co •
P. O. Box 117'3 � � � %
Southold, New York 11971 ct� r4r",� Iterations
Tele 765-1801 hone swe � i� $10.00 - Residential
(516) _ "/ NtV
' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT +I
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: 0,2 / ! /
APPLICANT ADDRESS: ?�
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/ter• _ -
1 Vii/
7
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU ION OR ALTERATION:
OWNER OF PROPERTY: •
OWNER MAILING ADDRESS: fes.
•
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section P' Block Lot
CROSS STREET: 4
.,(4-7(6
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature ofy.plicant
RECEIVED BY:
Clerk's Office
DATE: 6. 0
REceval
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