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JUDITH T. TERRY ; ` Town Hall, 53095 Main Road
TOWN CLERK t rZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS €f , .j �� Southold, New York 11971
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MARRIAGE OFFICER *+,20. Fax (516) 765-1823
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�160 .� 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. 968 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITIONAL CESSPOOL IN BARN AREA.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED.
Name Of Owner SCOTT, JOHN AND SANDRA
Mailing Address 1 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 2 lot 23.000
Cross Street COX LANE
Building Permit Number Cross Reference:
Issue Date: 4/02/93 Judith T. Terry
Southold Town Clerk
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® Town Hall
JUDITH T. TERRY , 53095 Main Road
' TOWN CLERK tr1va h P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS * •% Southold, New York 11971
MARRIAGE OFFICER
C.1✓ O �� Fax (516) 765-1823
® ®��1� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK I y J J __ —
TOWN OF SOUTHOLD \ "". z_
` ' 01993
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TO: Southold Town Building Department VV.
0s MI
FROM. Linda Cooper, Southold Town Clerk's Office \-4
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DATED: March 10, 1993 -cU' -,.'
Transmitted herewith is a copy of application No. A995 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for John and Sandra Scott .
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 - n� pp (� ,.�� nw
COMMENTS: a,®, ...4.,,.L-t..ZR.e� 51•, 0..AatL aLl_¢Y, . atasj?„..0-,
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._.-- Signature
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OFFICE OF THE TOWN CLERK ,,,' "
Town of Southold �.1'.� 1-111X
Judith T. Terry, Town Clerk ;' ��. �l/y=; Application No. �1��
Town Hall 53095 Main Road �� '_ = Construction
P. O. Box 1179 , = ' � ,
Alteration
Southold, New York 11971 = .z. M �•'
Telephone _ ''gi ��e' $10.00 - Residential
(516) 765-1801 =.R.. or $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATEV/04,
APPLICANT NAME: 1,9,,,--e....-0--n,e, SP---21-4--
APPLICANT ADDRESS: MO / 977,-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION ,
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: .744-54-57 '..1 ,4 5zcz
OWNER MAILING ADDRESS: 9 ,b1 re--0/
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OWNER PROPERTY ADDRESS: -a•-
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TELEPHONE NUMBER OF CONTACT PERSON: 02 ---1G-J67
TAX MAP NO. : Section A9 c)-- Block d— Lot ..7
CROSS STREET: 40/ (44/—
BUILDING PERMIT NUMBER CROSS REFERENCE:
-,
--2/ , •..°
Signature of Applica
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RECEIVED BY:
Town Clerk's Office
DATE:
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