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OFFICE OF THE TOWN CLERK
Town of Southold • � 4G,
Judith
Judith T. Terry, Town Clerk 4, �
Town Hall, 53095 Main Road
P. 0. Box 1179 ' '� � �
Southold, New York 11971 O ®! �0�-'�•�
Telephone L
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. A302 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Peconic Cesspool
ADDRESS: P. 0. Box 972
Mattituck, New York 11952
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
Replace existing cesspool with new type.
APPROVED - STAY WITHIN 15' OF EXISTING POOL.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Bennett Orlowski
OWNER MAILING ADDRESS: Box 266
New Suffolk, New York
OWNER PROPERTY ADDRESS : New Suffolk Road
New Suffolk, New York 11956
TAX MAP NO. : Section 110 Block 8 Lot 13
CROSS STREET: Oak Street
BUILDING PERMIT NUMBER CROSS REFERENCE:
Judith T. Te y
Southold Town Clerk
DATE : March 15, 1988
(TOWN SEAL)
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.JUDITH T. TERRY ���g 011oto TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
March 8, 1988
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A 306 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Bennett Orlowski
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 - \dC
DISAPPROVE -
COMMENTS: % l SI 0
\Cei (4.
Signature
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Date
OFFICE OF THE TOWN CLERK c5IF�(
Town of Southold Application No. /� 36,E
Judith T. Terry, Town Clerk w. �i
Town Hall 53095 Main Road ` c .z t••.'t 3 Construction
P. O. Box 1179 0` '® - g J Alteration
Southold, New York 11971
01 `A tResidential
Telephone
(516) 765-1801 ' Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT '
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
•
DATE F / e9Y
APPLICANT NAME:
APPLICANT ADDRESS: !! (' , /3,e 772.
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1& .L/L �y
OWNER MAILING ADDRESS: 40e
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OWNER PROPERTY ADDRESS: ��" •-e.
TELEPHONE NUMBER OF CONTACT PERSON: Ztr"- Y T
TAX MAP NO. : Section /M Block d Lot /3
CROSS STREET: 6.
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature of Applicant
RECEIVED BY:
own Clerk's Office
DATE: Hel
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