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JUDITH T.TERRY ` Town Hall,53095 Main Road
TOWN CLERK -s ', C P.O.Box 1179
REGISTRAR OF VITAL STATISTICS �` 1� Southold,New York 11971
MARRIAGE OFFICER =��� �'�iTelephone(516)765-1800�e Fax(516)765-1823
RECORDS MANAGEMENT OFFICER V/•
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. 1380 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
ADDITON OF AN OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. NEW POOL MUST BE
FURTHER FROM WELL THAN EXISTING POOL. EXCAVATION INSPECTION REQUIRED.
Name Of Owner MOORE, RUTH
Mailing Address 1 BOX 304
City St Zip CUTCHOGUE NY 11935
Property Address 1 WEST ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 5 lot 14.000
Cross Street WEST CREEK ROAD
Building Permit Number Cross Reference:
Issue Date: 9/06/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/
JUDITH T.TERRY ` ® Town Hall, 53095 Main Road
TOWN CLERK % g P.O.Box 1179
eboO Southold,New York 11971
REGISTRAR MARRIA VITAL E OFFICERISTICS �� ®� / Fax(516)765-1823
`: ®
RECORDS MANAGEMENT OFFICER 1 ����� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,,1 '
OFFICE OF THE TOWN CLERK ;,ti it (r F
TOWN OF SOUTHOLD
TO: Southold Town Building Department AUG 2 9 1995
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: August 28, 1995
Transmitted herewith is a copy of application No. A1432 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Ruth Moore
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:
G✓� J
APPROVE - ��?�I�O''
•
DISAPPROVE - fl-e)""7
COMMENTS: Maintain required setbacks from&jacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signa .re
Da�
f
� ! n
OFFICE OF THE TOWN CLERK „ '""""'%
Town of Southold ,.11 CORILK ,
�. Application No./4/1.4.1:7-
Judith T. Terry, Town Clerk ��Z �,.:_-
Town Hall, 53095 Main Road C Construction
P. O. Box 11792.
^' • Alteration
Southold, New York 119710.0
e $10.00 - Residential
Telephone ,40
2/
(516) 765-1801 = 1 > ,, ' ' $25.00 - Non-Residential
. , pi
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE a2/05---
APPLICANT
/ 0APPLICANT NAME: 6-a-or,$" .
APPLICANT ADDRESS: A 0 97®®
�6 if-0!”
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: >- `5Pj
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: '9 r
TAX MAP NO. : Section G f® Block Lot
CROSS STREET: � �
BUILDING PERMIT NUMBER CROSS REFERENCE:
1
1 7
Signature of Applicant
A
RECEIVED BY: / //
fir Town Clerk's Office
DATE:
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