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JUDITH T. TERRYz Town Hall, 53095 Main Road
TOWN CLERKt=1 Fri P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® ��" Fax (516) 765-1823
MARRIAGE OFFICER r,' 1 Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER g®1ilia
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FREEDOM OF INFORMATION OFFICER ��� �iir/rrrll.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1148 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
ADDITION OF AN OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN (AT LEAST) EXISTING DISTANCE FROM
ADJACENT WELLS. EXCAVATION INSPECTION REQUIRED.
Name Of Owner OLMSTED, ROBERT
Mailing Address 1 1220 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 1220 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 7 lot 14.002
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 6/09/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
It
JUDITH T. TERRY ...< Town Hall, 53095 Main Road
TOWN CLERK : IC a m P.O. Box 1179
cn w Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `Y® �� Fax (516) 765-1823
MARRIAGE OFFICER sj`' ®���' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER =_7®1 �0
FREEDOM OF INFORMATION OFFICER +�0�0,iiiil��i
OFFICE OF THE TOWN CLERK 1 I k
TOWN OF SOUTHOLD C5 Q M §i ,
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TO: Southold Town Building Department "��1f 6 1994
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 3, 1994 -Miry ..T.oF
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Transmitted herewith is a copy of application No. A1190 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Edward Krebs .
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 foilowin recommendation:
APPROVE
EXCAVATION INSPECTION
DISAPPROVE - 4 REQUIR /
COMMENTS: / r /
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OFFICE OF THE TOWN CLERK ,,'",,, -%
Town of Southold /
Application No.I( I°
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ; ; Construction
P. O. Box 1179 . =v ,_
Alteration
Southold, New York 11971 �to : - ���`
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Telephone =�® ,i� $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 $
DATE4,%4;// 4
APPLICANT NAME: 127 >
APPLICANT ADDRESS: %"� 972-- /l s�
SEPTIC CESSPOOL [/
DESCRIPTIONS OF PROPOSED CONSTRUCTION OR ALTERATION
7/276
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTER A TION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: � � C
l��evilr�„
TELEPHONE NUMBER OF CONTACT PERSON: C9-',/ r
TAX MAP NO. : Section /37 Block Lot it?
CROSS STREET: - ,re_
GC
BUILDING PERMIT NUMBER CROSS REFERENCE:
Awa ` ideili11101 1RIMED ,
Signature of Applicant
• RECEIVED BY: JUN 3 1994
Town Clerk's Office
Town Clerk Southold
DATE:
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