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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : •
1=2 az P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS :s' .��' Fax (516) 765-1823
MARRIAGE OFFICER ��' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 1 Ill
FREEDOM OF INFORMATION OFFICER l,��,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1286 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
ADDTION OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner MALON, STANLEY
Mailing Address 1 32845 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 32845 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 5 lot 4.005
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 2/06/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
of Mir:
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JUDITH T.TERRY ; ® �� % Town Hall, 53095 Main Road
TOWN CLERK % car g % P.O.Box 1179
s O 0 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �` ` . 0Fax(516)765-1823
MARRIAGE OFFICER .. 01
RECORDS MANAGEMENT OFFICER : ®.1 .0 $i,,� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER -„„ ,"•si
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OFFICETOWN OF OUTHOLD WN CLERK E,,y'` `°'�f ��, cS''o'
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TO: Southold Town Building Department -, , .eFROM: Linda Cooper, Southold Town Clerk's Office
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�a ,2, y
DATED: January 31, 1995 s0e ' ' ,.�
Transmitted herewith is a copy of application No. A1334 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Stanley Malon .
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 -
DISAPPROVE - /--
COMMENTS:
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Signatur
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OFFICE OF THE TOWN CLERK ,,,'"C""y
- Town of Southold �'e C,,,F1 01.11 e` /3 3 V
Judith T. Terry, Town Clerk ��
0 Application No.
Town Hall, 53095 Main Road Z .G - Cons •n_� �
; ,At
P. O. Box I $1 __ - • _
Southold, New York 11971 •tri $
Telephone ;`'O44 '.\ is $10.00 - Residential -L_
(516) 765-1801 _ 9/ 4 , ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL ,
Permit No.
Fee $
DATE 0/:/(30/3
APPLICANT NAME: (7 / `
APPLICANT ADDRESS: ea,' , � ' Z
. 7i € 4 / - /7 ,95-2.—
SEPTIC
/ ,5-zSEPTIC 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: j 77*��
OWNER MAILING ADDRESS /S— * '
er' ` 7 55,/-- Sis Ps'
, OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: %`,9"® 76 VP
TAX MAP NO. : section 677 Block S Lot K.
C STREET: '— 7- • .,elm— N -
BUILDING PERMIT NUMBER CROSS REFERENCE:
Ale i.---44 ' /#1
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Signature of Appl. nt
RECEIVED BY:
Town Clerk's Office 1
DATE: 2.
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