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JUDITH T. TERRY C Town Hall, 53095 Main Road
TOWN CLERK \a tea P.O. Box 1179
REGISTRAR OF VITAL STATISTICS (J� Southold, New York 11971
MARRIAGE OFFICER �! Fax (516) 765-1823
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 750 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
INSTALLATION OF NEW OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED SUBJECT TO NEWLY INDICATED PLACEMENT. YOUR PROPOSED NEW
CESSPOOL WOULD BE TOO CLOSE TO WATER SUPPLY. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner MASON, STEPHEN
Mailing Address 1 36 RIDGELY ROAD
City St Zip SMITHTOWN NY 11787
Property Address 1 9265 MAIN BAYV I EW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 3 lot 23.001
Cross Street VICTORIA DRIVE
Building Permit Number Cross Reference:
Issue Date: 9/09/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
7S
RECEIVES AUG 6 9991 t' `
3,"15 I
SEP 0 6 1991 Lr3 i A Townal��ll,� 095 Main Road •
DE .
TOWN OF SOUTAO go. 13 x 1 179
Rio Saidf, SO til old,N w York 11971
JUDITH T. TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OFTHE TOWN CLERK
TOWN OF SOUTHOLD
August 6, 1991
To: Southold Town Code Enforcement 'Officer -
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A770 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Stephen Mason
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 - nn
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' OFFI CE OF THE TOWN CLERK . ,,,,'"',,"'',
Town of Southold .'' \VULk�•
Town Clerk ��' ��- • OGy Application No.
Judith T. Terry, �/
`" •Construction
Town Hall, 53095 Main Road Z 3 � � ;
P. O. Box 1179 ; oT; -. '��, •
Alteration
Southold, New York 11971
'toe
Telephone ,j- �Q �•� $10.00 - Residential
(516) 765-1801 =��.� �,
�' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
• for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. -
Fee .$
DATE Cil
APPLICANT NAME: / 17t,f.-c
APPLICANT ADDRESS: /!/ 6-ir
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Airolfrd
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: fp -i/ - /- ,
k
OWNER PROPERTY ADDRESS: -9'� GS- /e-ge
TELEPHONE NUMBER OF CONTACT PERSON: r4 6 s's/
TAX MAP NO. : Section t'f Block 3 Lot 2-5,
CROSS STREET: / its
BUILDING PERMIT NUMBER CROSS REFERENCE:
if,"/ //
Signature of A•"•Iicant
RECEIVED 113Y:
own Clerk's Office
DATE: 5 co7Q/
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