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JUDITH T. TERRY ° -. ,d',. 7 Town Hall, 53095 Main Road
� .—-- P.O. Box 1179
TOWN CLERK Ss
REGISTRAR OF VITAL STATISTICSIZP ,, Southold, New York 11971
Fax (516) 765-1823
MARRIAGE OFFICER G�,e
�6�® sem, �` 1 Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 743 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 AN OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 12'0" SEPARATION. CALL FOR NECESSARY
EXCAVATION INSPECTION.
Name Of Owner SCOGGIN, LINDSAY
Mailing Address 1 2220 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 2220 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 2 lot 8.000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/26/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Jt� 1 ( ill '
P
XL 2 5 �' .ht Town Hall, 53095 Main Road
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P.O. Box
1179
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_ � Southold, New York 11971
BLDG DEPT.
,JUDITH T. T ETRyTOWN OF SOUTHOLDTELEPHONE
TOWN CLERK "''
(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
July 25, 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 765 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Lindsay Scoggin
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 - X
DISAPPROVE -
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1„ ,�� Signature ' � ,�'S
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OFFICE OF THE TOWN CLERK ,.,,""""'
Town of Southold •0140Wir
Town Clerk �' � Wire
Judith T. Terry, il/ Application No. 7-(415—
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Town Hall, 53095 Main Road Z : . ; Construction
P. O. Box 1179 � c `_, rn
Southold, New York 11971 . y1 .W$ Alteration
Telephone ��' $10.00 -Residential
(516) 765-1801 = .�
�� $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 5-1 (0 S
Fee $ /®
DATE
APPLICANT NAME.:
APPLICANT ADDRESS: Rd 972 .
SEPTIC CESSPOOL
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: 1//t,'/$fr Sc0 fiiGj/
OWNER MAILING ADDRESS: 21.2 2.0 /' ✓� e i(
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /b LI Block 2_ Lot 9
CROSS STREET: >57?v,A
BUILDING PERMIT NUMBER CROSS REFERENCE:.
Signature of .i,'plicant
REC€a V€-D B Y:
Town Clerk's Office
DATE: '7 5 (
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SEWER& DRAIN SERVICE
P 0. BOX 972 BRAY AVENUE MATTITUCK, NEW YORK 11952
(516)298-9658
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