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JUDITH T. TERRY < Town Hall, 53095 Main Road
TOWN CLERK i; P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = t%' Fax (516) 765-1823
MARRIAGE OFFICER • •
Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER -- 9
FREEDOM OF INFORMATION OFFICER % ii°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1140 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
REPLACE OLD CESSPOOL IN AN EXISTING SYSTEM WITH NEW TYPE.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, WATERS BODIES, AND A MINIMUM OF 2' ABOVE
GROUND WATER. EXCAVATION INSPECTION REQUIRED.
Name Of Owner NEVILLE, MICHAEL
Mailing Address 1 1900 NORTH OAKWOOD ROAD
City St Zip LAUREL NY 11948
Property Address 1 1900 NORTH OAKWOOD ROAD
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 6 lot 7.000
CrossStreetPECONIC BAY BOULEVARD
Building Permit Number Cross Reference:
Issue Date: 5/26/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
4OL
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JUDITH T. TERRY ,1 :44Town Hall, 53095 Main Road
TOWN CLERK z Co T P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS VS • Southold, New York 11971
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Fax (516) 765-1823
MARRIAGE OFFICER ®
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�� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ( L II r
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TO: Southold Town Building Department I ' 2 0 /9c4
FROM: Linda Cooper, Southold Town Clerk's Office! ..
DATED: May 20, 1994 • aux
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- Transmitted herewith is a copy of application No. A1181 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Michael Neville
•
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.
44ALGt-c"-d-
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - `•----- EXCAVATION 0 gSP Tli
DISAPPROVE - REQUIRED
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COMMENTS: .: eG at ,% _,` ,
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RECEIVED
47)-27,4
MAY 2 6 1994 signator
town Clerk Southofd `' -7; K
Date
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OFFICE OF THE TOWN CLERK �,��'" --.
Town of Southold •••'1 cAVULk'`, -_ Application No��Cfl
Judith T. Terry, Town Clerk �•� ®{ _ ��
Town Hall, 53095 Main Road Z �=` ' Construction Q�
P. O. Box 1179 z
Southold, New York 11971 � = ;� Alteration
Telephone . 4410
,� �0�°.!'� $10.00 - Residential
(516) 765-1801 --_ 116°
, '' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT '
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 51/10,4
APPLICANT NAME: �
APPLICANT ADDRESS: /;°, .47 972_
44.- A ///951-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /
� i' /
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: / 9L-d /✓
c fk�57.3 ��� , - ,, 9 5,'
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: y,C- fG3r
TAX MAP NO. : Section /2-7 Block C, Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
.04rif. -0(A11
Signature of AT/cant
RECEIVED BY: I�
Town Clerk's Office.
DATE:
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