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Town Hall, 53095 Main Road
a - `' P.O. Box 1179
=® �. n �, *� Southold, New York 11971
JUDITH T.TERRY ®d �� 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. 395 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 NEW OVERFLOW TO EXISTING CESSPOOL SYSTEM.
APPROVED AS SUBMITTED. NEW POOL TO BE NO FURTHER THAN 10' 0" FROM
EXISTING POOL.
Name Of Owner JACOBI, HENRY
Mailing Address 1 FOUNDERS PATH
City St Zip SOUTHOLD NY 11971
Property Address 1 FOUNDERS PATH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 64.00 block 4 lot 16. 000
Cross Street LANDING ROAD
Building Permit Number Cross Reference:
Issue Date: 9/13/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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%. �•• P.O. Box 1179
_'��� l i�� Southold, New York 11971
.JUDITH T. TERRY 1.'"o'io° _ TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 12, 1988
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A401 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Henry Jacobi
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. e
Linda J. Cooper
* * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - X
DISAPPROVE - n/�
COMMENTS: ca,,, y„ e. 'a u�y t„ad._
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Signature
5f' $ �
Date
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OFFICE OF THE TOWN CLERKC.OF®C ft
Town of Southold � � �'
Judith T.. Application Terry, Town Clerk � �f pp No. J
Town Hall, 53095 Main Road ,V,V4 Construction
P. 0. Box 1179
Alteration
Southold, New York 11971
Q( 'Y Residential '
Telephone _ ,• -
(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 .$ /6
/ DATE
APPLICANT NAME: �//��r4L/7,/9; / /06i// £7,0,/3 /2 e 5,1,0
APPLICANT ADDRESS: 4," 972-
f/4-'o7vCli' /1/ y /19.5-7--
SEPTIC
,'95 -
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
. /474.2®h. 1"0 L'3:15./7;•2 y5/a1/ 515774
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: //6"-A.44 V4,6.67 Js
OWNER MAILING ADDRESS: fr-dvvA./9c.j- ,' i::3j
���•�7/4///' o 4 7o 4 //f Z/
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ,z2-9,'?‘5"F---
TAX MAP NO. : Section Via, Block T" Lot /4
CROSS STREET: A- (�<<-y fZy'
BUILDING PERMIT NUMBER CROSS REFERENCE:_
Signature o�ppican
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RECEIVED BY: W'. L-&--I
RE,,0,'sn CI_' k's Offi 'e
DATE:
SEP 121988
lam Clerk Southold
411
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