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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER � Fax (516) 765-1823
;y1® ® l� 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. 893 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 AN OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. STAY OUT OF DRIVEWAY. HOLD 10'0" BETWEEN
POOLS. EXCAVATION INSPECTION REQUIRED.
Name Of Owner MONSELL, ABLERT
Mailing Address 1 4045 GRAND AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 SAME
City St Zip 0000
Tax Map No. section 107.00 block 1 lot 9.000
Cross Street KNOLLWOOD ROAD
Building Permit Number Cross Reference:
Issue Date: 8/10/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
JUDITH T. TERRY ' Town Hall, 53095 Main Road
TOWN CLERK ® _ r;� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS lg % Southold, New York 11971
MARRIAGE OFFICER #:' Telephone (516) 765-1801
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AE" �i OFFICE OF THE TOWN CLERK
1 i �, "I,.,.. ";41992 ;, FGti
f ! TOWN OF SOUTHOLD
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Y'fit1 8 L i:!0[1 1 Aug. 4, 1992
To: Southold Town Code Enforcement 'Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A917 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Albert Monsell .
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 - x
DISAPPROVE -
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COMMENTS: 1,5_,A1 Qm /b -O -'
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OFFICE OF THE TOWN CLERK ,,,,,,,,,".._
Town of`Southold .'' �FFOLA'e
r'J _ Application No: 9 7
Judith T. Terry,- Town Clerk ��0 _ G�;
Town Hall,. 53095 Main Road ; Z
, Construction
P. O. Box 1179
:frit ^' ; Alteration
Southold, New York 11971 : �� -
Telephone ' ,y _�O�i� -, '$10.00 - Residential
(516) 765-1801 = �l �, 0 . $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
APPLICANT NAME: 6.J j
APPLICANT ADDRESS:A d,. ( 972_ •
SEPTIC CESSPOOL '
DESCRIPTION O'F PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued. •
•
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
•
OWNER OF PROPERTY: ✓ ,��;� •
OWNER MAILING ADDRESS: ge*S—
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 2: 92- ?6' 5g
TAX MAP NO. : Section • /07 Block / - Lot 9
CROSS STREET: Ll/ -
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sig #ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: -
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