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4 Town Hall, 53095 Main Road
' P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY
��� FAX(516)765-1823
-
TOWN CLERK TELEPHONE(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. 627 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
ADDITON OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. DO NOT PLACE ANY CLOSER TO WELL POINT.
EXCAVATION INSPECTION REQUIRED. CALL 765-1802 FOR AN APPOINTMENT.
INSPECTION REQUIRED PRIOR TO COVERING.
Name Of Owner SALZMAN, RACHEL C.
Mailing Address 1 42 MAXWELL ROAD
City St Zip GARDEN CITY NY 11530
Property Address 1 SALT LAKE VILLAGE
SALT LAKE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 144.00 block 5 lot 22.000
Cross Street SAILOR ROAD
Building Permit Number Cross Reference:
Issue Date: 7/20/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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Town Hall, 53095 Main Road
1 �� � P.O. Box 1179
_ ltl� Southold, New York 11971
JUDITH T. TERRY 4...4.4100$rO
TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD C
July 19, 1990 E �M...
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JUL 9[e"
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To: Southold Town Code Enforcement 'Officer
BLDG. DEPT.
From: Linda J. Cooper, Southold Town Clerk's Office TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No. A645 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Rachel C. Salzman
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 followin recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Atte-` r�� A ✓f ///✓moi.`
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� f VALOP.
Signature
Date /
OFFICE 6i,F THE TOWN CLERK ��,,,'",,,,`'',%,
Town of Southold ��•i'l'atfo1.Kt'Oy_ Application No. ��
Judith T. Terry, Town Clerk ���� �r
Town Hall, 53095 Main Road Z Construction 1.----
P.
P. O. Box 1179 ; v ryre •
Southold, New York 11971 .cf, 5.. _^ ,�� Alteration
Telephone _w,j- - �?i' $10.00 - Residential is
(516) 7 65-1801 �.� ��
,, �' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
y CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE illrho
APPLICANT NAME: //°- P
APPLICANT ADDRESS: A 97Z—
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION p ALTERATION
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Ca-(2.---72 '
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION•
OWNER OF PROPERTY: C --it-42/ gie ,,
OWNER MAILING ADDRESS: 4`2-- tiG%41 � - -
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OWNER PROPERTY ADDRESS: • - / / = los-awe`' •
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Nei Block � Lot 7 7.—
CROSS
CROSS STREET: 56 -
BUILDING PERMIT NUMBER CROSS REFERENCE:
.,11/70'‘'
Signature f Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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