HomeMy WebLinkAboutJacobi SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 677 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 ONE OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD12°011 SEPARATION AND CALL FOR EXCAVATION
INSPECTION BEFORE BACKFILLING.
Name Of Owner JACOBI, HENRY JR.
Mailing Address 1 BOX 165
City St Zip SOUTHOLD NY 11971
Property Address 1 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 9 lot 3.000
Cross Street KENNY ROAD
Building Permit Number Cross Reference:
Issue Date: 1/14/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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BLDG. DEPT. Zi v.t,fa r #�. 7 A, r.77—
TOWN OF SOUTHOLD % '° �.. % Town Hall, 53095 Main Road
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� J�,+' ,._-=�,° ,��'�. P.O. Box 1179
4 i 1 Southold, New York 11971
JUDITH T. TERRY +�'""""ie"" TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
January 10, 1991
To: Southold Town Code Enforcement 'Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No.A 695 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Henry Jacobi Jr. .
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 J. Cooper
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* * * �� * * * * * * * *
I have nevi n -- application and location map of the project listed
above an. � a w e following recommendation:
4"PROVE - Dc
DISAPPROVE - 1j�, fi (� CP
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OFFICE OF THE TOWN CLERK ",,,,
' Town of Southold .1" .0Fafro
T. Terry, Town Clerk �Gy� Application No. 6cfr-
Judith
Town Hall, 53095 Main Road ; + `" L Construction
P. O. Box 1179 c _ ',mac,
Southold, New York 11971 : cn : Alteration
Telephone =O,fleo1 ��� ' $10.00 - Residential
(516) 765-1801 * ,, ''. $25:00 Non Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /9/7/
APPLICANT NAME: .ere%./rYG?,L
APPLICANT ADDRESS: /IO 727.
SEPTIC CESSPOOL i
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ‘714.
OWNER MAILING ADDRESS: �. �- /63'
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OWNER PROPERTY ADDRESS: , -
TELEPHONE NUMBER OF CONTACT PERSON: f'e.t P'
TAX MAP NO. : Section 'J~7 Block Lot 3
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CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Ape/cant
RECEIVED BY: f� '
own Clerk's Office
DATE: / /6 /c/
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