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JUDITH T.TERRY t�� = y� •
Town Hall, 53095 Main Road
TOWN CLERK ; y _ P.O. Box 1179
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Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER � 011 Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER : l * '1►���� 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. 1410 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 A CESSPOOL 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 ROBINSON, PATRICIA
Mailing Address 1 920 NAUGLES DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 920 NAUGLES DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 5 lot 13.000
Cross Street LUTHERS.ROAD
Building Permit Number Cross Reference:.
Issue Date: 11/14/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �tt_° yt Town Hall, 53095 Main Road
TOWN CLERK ; ci3 P.O. Box 1179
- I Southold,New York 11971
REGISTRAR OF VITAL STATISTICS : ® �,�� Fax(516) 765-1823
�
MARRIAGE OFFICER =;4® se Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 1iNg
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK i'rIf F fLSf 1`
TOWN OF SOUTHOLD =;-� ' NOV — 1 1995
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office -
DATED: October 31 , 1995
Transmitted herewith is a copy of application No. 1463 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Patricia Robinson
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature
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Dat
OFFICE OF THE TOWN CLERK ,,,,""""'%,
Town of Southold �FFD(f(e'
Judith T. Terry, Town Clerk
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Application No. / tp�
Town Hall, 5305 Main Road '' '
ti. Construction
P. O. Box 1179 t=3 _. ,T, �
Southold, New York 11971 tf� '; .: - Alteration
$
Tele hone y� " Qr ' $10.00 - Residential
p
(516) 765-1801 '.01 41 ' $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 /0/411/4-c.
APPLICANT NAME:
APPLICANT ADDRESS: i i 9 z&
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
:1"/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR✓fTION,OR ALTERION:
OWNER OF PROPERTY: _
OWNER MAILING ADDRESS: 9,029 'ic%� , .
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 9g-` 96 5'12
TAX MAP NO. : Section ? ? Block Lot /3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature o ° pplicary�
(//
RECEIVED BY:
Cown Clerk's Office
DATE: /0 l ( ( Y
PRLIIDENT
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