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JUDITH T. TERRY :� A �°"•
' '- Town Hall, 53095 Main Road
'y � =` `'ti , : P.O. Box 1179
TOWN CLERK ® :.• f= t� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS K F� Vie'CY 7' ��� Fax (516) 765-1823
MARRIAGE OFFICER 49420
� �' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = x/11'
FREEDOM OF INFORMATION OFFICER _���„�/iii-���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1230 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : P. 0. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner PALUMBO, FRANK
Mailing Address 1 18717 87TH ROAD
City St Zip JAMAICA ESTATES NY 11432
Property Address 1 6575 BAY AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 5 lot 6.001
Cross Street HAYWATERS ROAD
Building Permit Number Cross Reference:
Issue Date: 10/24/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
S 'rrrIIlllgq�,''
/
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK - P.O. Box 1179
II �' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t% Fax (516) 765-1823
MARRIAGE OFFICER ���'� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER °�® il
FREEDOM OF INFORMATION OFFICER --�Irllrrart'
OFFICE OF THE TOWN CLERK -
TOWN OF SOUTHOLD `P"
TO: Southold Town Building Department " 0 T'
gh
FROM: Linda Cooper, Southold Town Clerk's Office -.. ,- U1 1 319
DATED: October 12, 1994 - -
Transmitted herewith is a copy of application No. A1274 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Frank Palumbo
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: 5�
APPROVE - e/ C VAA IIO �NSPECTIIO
REQUBRED
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
REC • 4
3 ,yS , � a - a-2— Ailir
OCT 2 ` 1994 Signatur-
Town Clerk Southold /,',4-7/Ar
Date
OFFICE Of THE TOWN CLERK ,,,,'",,,,"
' Town of Southold X00 gitir
4a Application No/4-10r7
Judith T. Terry, Town Clerk ���%0®:, - , G�
Town Hall, 53095 Main Road Z • ; Construction
P. 0. Box 1179 ; o7; • nm .
Southold, New York 11971 .c,rz __ ' y�,�� Alteration
Telephone =,y0,��o ������� $10.00 - Residential a/
(516) 765-1801 : 1 , $25.00 - Non-Residential
_,,
011
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
' SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE /o/ ' ® f ,
, , ,
APPLICANT NAME: t;"
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APPLICANT ADDRESS: ,e) 4-69‘,. - 7Z.
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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 CONS . UCTION •R AR TION:
OWNER OF PROPERTY: ,7_,,e j __
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OWNER MAILING ADDRESS: /,;. 7-/1-
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,� P ,C4-3OWNER PROPERTY ADDRE 1 aS'' , -
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /Q 41 Block Z Lot G,
STREET: ial ./ L�_
BUILDING PERMIT NUMBER CROSS REFERENCE:
"4„ _ ,,,,,#".
Signatu of Applicant
RECEIVED BY: ' Atir 22 a
gown lerk's Office ,
DATE: / ,0 /47(3....<-.
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