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JUDITH T. TERRY � f' f Town Hall, 53095 Main Road
TOWN CLERK 4 r P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER W' C2). Fax (516) 765-1823
��r Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 666 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 OLD CESSPOOL WITH NEW TYPE.
APPROVED AS SUBMITTED. HOLD 2' ABOVE WATER TABLE AT BASE. HOLD MAXI-
MUM 10' BETWEEN POOLS. EXCAVATION INSPECTION REQUIRED.
Name Of Owner KENDALL, GEORGE
Mailing Address 1 PECONIC BAY BLVD
City St Zip LAUREL NY 11948
Property Address 1 PECONIC BAY BLVD.
City St Zip LAUREL NY 11948
Tax Map No. section 128.00 block 6 lot 16.000
Cross Street NORTH OAKWOOD
Building Permit Number Cross Reference:
Issue Date: 12/05/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town Cierk Sauttioiti
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=i';'-fie-..' ;, , P.O. Box 1179
�_i , l\ P Southold, New York 11971
JUDITH T. TERRY .."'" 0 TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD '
December 4, 19'100,1113
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ll C � alt yt
t, DEC - 41990 1 f t/i
To: Southold Town Code Enforcement 'Officer " 1_ ;; i'l
From: Linda J. Cooper, Southold Town Clerk's Office --- .. y'`-ct_c
Transmitted herewith is a copy of application No. A682 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for George Kendall ,
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. `n
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® V Linda J. Cooper
* ila IA * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - K.
DISAPPROVE - (� L Lep
COMMENTS: 0,.... i,,, Ca.ltarPwS .
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Signature
Date
1
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,OF Fi'CE OF THE TOWN CLERK , ,,""""'
Town of Southold ++'++c\\FFULir ' X./ 4--
Town
Judith T. Terry, Town Clerk ++'+moo W ." Application No.
Town Hall, 53095 Main Road ;� ` . Construction
P. O. Box 1179 Alteration
Southold, New York 11971 J;
Telephone `y0� e_&\%r $10.00 - Residential`Noe�
(516) 765-1801 " 1
��, ' $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 71 �,��
APPLICANT NAME:
APPLICANT ADDRESS: 972.
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
� . ✓
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU,; TION OR ALT55ATION:
OWNER OF PROPERTY: r " , " J _
OWNER MAILING �A
ADDRESS: �� 7
OWNER PROPERTY ADDRESS: �.
TELEPHONE NUMBER OF CONTACT PERSON: c
6r
TAX MAP NO. : Section / gP Block Lot 4
CROSS STREET: ,/moo Off.-14.4//7"7"---0Z--
BUILDING
1 /
BUILDING PERMIT NUMBER CROSS REFERENCE:,
ALatf.4-4/1/1,11
1,
Signature of Appli nt
RECEIVED -BY: 6
Town CI rk's Office
DATE: A,2- ?c..)
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