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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK • ® , • P.O. Box 1179
' ' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS1` Fax (516) 765-1823
MARRIAGE OFFICER o Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER �j-t
FREEDOM OF INFORMATION OFFICER �ir��'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1172 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. O. BOS 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDTION OF NEW TYPE OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, WATER BODIES AND MINIMUM OF 2' ABOVE
GROUND WATER. EXCAVATION INSPECTION REQUIRED.
Name Of Owner MACDONALD, BRUCE
Mailing Address 1 6670 SKUNK LANE
City St Zip CUTCHOGUE NY 11935
Property Address 1 6670 SKUNK LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 140.00 block 5 lot 7.000
Cross Street HAYWATERS DRIVE
Building Permit Number Cross Reference:
Issue Date: 8/01/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY • '. . —`. L %'11s' own Hall, 53095 Main Road
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TOWN CLERK ® r-t+ I _ P.O. Box 1179
Vs �: 51 thold, New York 11971
REGISTRAR OF VITAL STATISTICS Vs® • �.',,si,-- n � ?� ax (516) 765-1823
MARRIAGE OFFICER 4`' y�®+'est,-N p►� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER _"S®1 1. ij0
FREEDOM OF INFORMATION OFFICER `: -..-,•10r11,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 21, 1994
Transmitted herewith is a copy of application No. A1216 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
' - Peconic Cesspool for Bruce MacDonald
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.
//L6(--u.'
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following/ recommendation:
APPROVE - v
DISAPPROVE - EXCAVATION
EyCOMMENTS: r2�.A�9 . �. ,�,� V f �` . f
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Signature
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Date
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OFFICE OP THE TOWN CLERK �,,,, ,,
Town of Southold ��•'�� � IKeo Application d. 02/k,
Judith T. Terry, Town Clerk � � Gy
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Town Hall, 53095 Main Road = Construction ' T
P. O. Box 1179 . = „
` v '47/ Alteration v
Southold, New York 11971
- 0r,� $10.00 - Residential
Telephone -----.741_ 491
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(516) 765-1801 = ".1 4, $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION, or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 7,i',,' v
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APPLICANT NAME: �"���7e;e... -�' //
APPLICANT ADDRESS: Al ,4, U�G Z
727.-/
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 ALTER TION: •
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: ,67‘2
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section f G Block 5- Lot ?
CRO-SS STREET: ;��� r
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signa ure o 'pp i ant
RECEIVED BY:
Town Clerk's Office
DATE:
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