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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK c r' P.O.Box 1179
REGISTRAR OF VITAL STATISTICS S O , Southold,New York 11971
MARRIAGE OFFICER 0 � 1 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER t `D � Telephone(516)765-1800
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. 1201 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
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 PARKER, ROBERT AND DONNA
Mailing Address 1 P. O.BOX 1568
City St Zip MATTITUCK NY 11952
Property Address 1 15845 ROUTE 48
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 101 .00 block 1 lot 13.000
Cross Street ALVAH'S LANE
Building Permit Number Cross Reference:
Issue Date: 9/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY . /.... Town Hall, 53095 Main Road
TOWN CLERK : ® P.O. Box 1179
VA , Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ". 00® tt Fax (516) 765-1823
MARRIAGE OFFICER ,� �® .6• Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®1 y�•
FREEDOM OF INFORMATION OFFICER „�iiri...°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: September 6, 1994
Transmitted herewith is a copy of application No. A1246 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Robert & Donna Parker
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. —
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Linda J. Cooper `,
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I have reviewed thea application and location mapof the _� z' is
pp pr\o ec#,,Misted ��
above and make the following recommendation: z,q ,, -
EXCAVATION 1 SPEC �� �V�ee,:
APPROVE — L/ EQUI `� ,4 v.-d . �`r
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DISAPPROVE — o ��'
COMMENTS: 9 liy. ✓fes i�� 4.7 /J ;
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Signatur
Date _.
OFFICE OF THE TOWN CLERK ,,,,'",,,"
Town of Southold .''� \\FOLK • I
�0 Application No. / ..2.... 5/,
5/,
Judith T. Terry, Town Clerk ��'�% - • _ GyJ;
Town Hall, 53095 Main Road �, ; Construction
P. O. Box 1179 ; p =c %
Southold, New York 11971 :tte :' i,; Alteration
Telephone % °04 0O, : $10.00 - Residential t---'(516) 765-1801 1 ��,
�, $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
, for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 9-- 6 —9/
APPLICANT NAME: g_ .- 'v, X
APPLICANT ADDRESS: /vP f-py( X71.
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SEPTIC CESSPOOL
DESCRIPTION 0 PROPOSED CONSTRUCTION O' , LTERATI•N
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST ' ; CTION OR ALT 'ATION:
OWNER OF PROPERTY: / , "„:_ele....7
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OWNER MAILING ADDRESS: ,,,a. 6-,2 /_5"-cep
OWNER PROPERTY ADDRESS: /2:1-74 ._,
TELEPHONE NUMBER OF CONTACT PERSON: /.P-,„e_-____9‘557.
TAX MAP NO. : Section /0 / Block / Lot /3
CROSS STREET: g.1 94-‘5 4 ''-
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature o Applicant
RECEIVED BY: /1/ AZ....(A-1`vg—e._____
Ts k' Office
97 /9/DATE:
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