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JUDITH T.TERRY 1 Town Hall,53095 Main Road
TOWN CLERK k P.O.Box 1179
REGISTRAR OF VITAL STATISTICS •�� ��, Southold,New York 11971
MARRIAGE OFFICER Fax(516)765-1823
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RECORDS MANAGEMENT OFFICER ®✓`( IT./
Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER '
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1320 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 A 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 MALONEY, JAMES A.
Mailing Address 1 505 BUNGALOW LANE
City St Zip MATTITUCK NY 11952
Property Address 1 505 BUNGALOW LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 3 lot 7.000
Cross Street MARRATOOKA ROAD
Building Permit Number Cross Reference:
Issue Date: 4/21/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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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 STATISTICS ,-< .- �� Fax (516) 765-1823
MARRIAGE OFFICER -V," .A%. Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ' ii
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FREEDOM OF INFORMATION OFFICER ...•, iii--
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ,. << � ,
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TO: Southold Town Building Department ,�9� -,�. /%
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FROM: Linda Cooper, Southold Town Clerk's Office �. /6),,
DATED. April 17, 1995 _,-, -`" _,, `9S
Transmitted herewith is a copy of application No. 1369 for an •
ALTERATION PERMIT for a cesspool or septic system submitted by
- Peconic Cesspool for James Maloney .
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.
iccc'
Linda J. Cooper
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I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - v
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
411111 ,0( - 4
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Date
OFFICE OF THE TOWN CLERK ,,,'"""''--
-Town.of Southold io"stf��K�►�" ����
Judithc .' Terry, Town Clerk ' l/ . Application No.
Tow_ n Hall, 53095 Main Road Construction
P. O. Box 11791-r11Alteration
Southold, New York 11971 N
T Telephone 0,�4, ��O�i�� $10.00 - Residential
(5 6) 765-1801 1 ,, '� $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 il/7 Jii-ed-4-71.--;2.-APPLICANT NAME: ii-ed-4-71.ii-ed-4-71.--;2.-
APPLICANT ADDRESS: A p„L 9 7
SEPTIC CESSPOOL e�
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUC ION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: Sc) S
OWNER PROPERTY. ADDRESS: �---
TELEPHONE NUMBER OF CONTACT PERSON: '
TAX MAP NO. : Section /o?3 Block -3 Lot 7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
'
natur off Applicant
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RECEIVED BY:
Town Clerk's Office
DATE: i_ ( 7_ �,�
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