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JUDITH T. TERRY Z Town Hall, 53095 Main Road
TOWN CLERK :
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JUDITH T. TERRY ; i► Town Hall, 53095 Main Road
TOWN CLERK ® P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS VI ` • Southold, New York 11971
Fax Fax (516) 765-1823
MARRIAGE OFFICER ;_a, 1 ��®���' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK ,4/, „
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TOWN OF SOUTHOLD '�` ,„,
TO: Southold Town Building Department ,oz. ,� d`
FROM: Linda Cooper, Southold Town Clerk's Office V
DATED: April 12, 1994 �sip�E` 4>;
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Transmitted herewith is a copy of application No,4 1153 for a
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Joe Moisa Jr. .
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. �Q(- ,,
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of•the project listed
above and make the following recommendation:
APPROVE - EXCAVATION INSPECTION
REQUIRED
DISAPPROVE -
COMMENTS: fr, ,
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APR 1- (sr-/ I-t- Si•naf re /
1994 /-6.
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Date
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OFFICE OF "THE TOWN CLERK �, ,,,,,,,,,"
Town of Southold ��•'� c VULKep Application No.
Judith i'. Terry, Town Clerk �OHO`.. Gy /
Town Hall, 53095 Main Road Z ` - Contra_ction•
P. 0. Box 1179 • %
Southold, New York 11971 cpti ,� Iteratio
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Telephone ` ,��0 -
AC" $10.00 - Residential
(516) 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 e
APPLICANT NAME: ,r fes`
APPLICANT ADDRESS: /�/
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SEPTIC CESSPOOL
DESCR ' N OF PROP'SED ONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU . ION OR ALTERA.TION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: d- r iete
17/017
OWNER PROPERTY ADDRESS: -
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /0 Block /0 Lot vZd v
CROSS STREET: J/
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applic j
RECEIVED BY: 4.44.cax„...
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Town CI k's (90(117-13
DATE: L/'
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