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JUDITH T. TERRY i Town Hall, 53095 Main Road
TOWN CLERKv T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Cl' Southold, New York 11971
MARRIAGE OFFICER ‘46) ��` Fax (516) 765-1823
`9 ® .�• Fax
(516) 765-1801
11111
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 696 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : DANIEL AND KIM MAGGIO
Address 1 : 5 WASHINGTON DRIVE
City St Zip HAMPTON BAYS NY 11946
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILEY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 5/24/90.
Name Of Owner MAGGIO, DANIEL
Mailing Address 1 5 WASHINGTON DRIVE
City St Zip HAMPTON BAYS NY 11946
Property Address 1 WELLS ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 2 lot 11 .000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 4/02/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
=` Town Hall, 53095 Main Road
'-\.5"3?) P.O. Box 1179
✓ � • � { Southold, New York 11971
JUDITH T.TERRY - i TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR 01-VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: March 27, 1991
Transmitted herewith is a copy of application No. 715 for a Cesspool/
Septic Tank Construction Permit submitted by:
Daniel & Kim Maggio •
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I
have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE
Comments: Q.o �.,, �ae � catcv %.hm-
‘,4-1, 1-441
.4
—1\lt\‘`1°\
\CC. ak. &A,
Signature
APR 02 1991 4\���\
Dated
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OFFICE OF THE TOWN CLERK
Town of Southoldr,;
Judith T. Terr , Town Clerk �:.�F , r. �` Application No, 7 L5
Town Hall, 53095 Main Road , -•>„ _ T} •'— ,r Construction 1/
P. 0. Box 1179
Southold, New York 11971 . Alteration
;,u/ •lk Residential >�
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ h
DATE rno,(c) ��{ �GR
APPLICANT NAME: Ki(Y) M(aC ( C Dan 1-e ( Moci3 ( e
APPLICANT ADDRESS: )Q rm�},1
SEPTIC CESSPOOL
DESCRIPTIO,N OF PROPOSED CONSTRUCTION OR ALTERATION �Ccpc5�c
1n
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Oc 'u; 1 fro (31Q
OWNER MAILING ADDRESS:L t:\11 7) (fe
my v- P . _ Q
OWNER PROPERTY ADDRESS: `&isoieK. up-6 L Pck ercon �G
TELEPHONE NUMBER OF CONTACT PERSON: `-03- a367 Taw, f6A
TAX MAP NO. : Section (2) '(Q Block Lot I (
CROSS STREET: mO R 8 y 3
BUILDING PERMIT NUMBER CROSS REFERENCE:_
C 1
Signature tf is pplicant
RECEIVED BY: 4, 411, itO
T. n Crer ' Office
DATE: `3 74
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