HomeMy WebLinkAboutPolistira 46(01-V V afre;
JUDITH T. TERRY
AT Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS :� Southold, New York 11971
MARRIAGE OFFICER � ® C) ,-4V Fax (516) 765-1823
- �! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 894 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 POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED.
Name Of Owner POLISTIRA, FRANK
Mailing Address 1 LINDA ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 LINDA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 2 lot 38.000
Cross Street RHODA ROAD
Building Permit Number Cross Reference:
Issue Date: 8/17/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY "., Town Hall, 53095 Main Road
TOWN CLERK t) P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER IP O ��!' Fax (516) 765-1823
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(516) 765-1801
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OFFICE OF THE TOWN CLERK ii 5,I ,t , F i'i
TOWN OF SOUTHOLD 0 Ek\ l';,6 c 1 1992
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August 7, 1992 1= ; ' " `
TOWN OF SOUTHOLD I
To: Southold Town Code Enforcement 'Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A918 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Frank Polistira .
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 - IC
DISAPPROVE —
COMMENTS: Q ,¢40‘, C. CQ. M Cara LI eta .
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i'`" ,^ Signature
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Date
OFFICE OF THE TOWN CLERK ,,,,'"',,""'',
Town of Southold .•' \VRA'
Town Clerk � �� 4, Application No. lir-
Judith
T. Terry, �, •
Town Hall, 53095 Main Road ' ; '; Construction
P. O. Box 1179 . v _ ,'��, z
Southold, New York 11971 cn �� Alteration Lr •
Telephone �Q�/•' $10.00 - Residential L..i
(516) 765-1801 • = Ol
' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION . •
for
-CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. Q/
Fee $ L6
• DATE
APPLICANT NAME: / ,- -
APPLICANT. ADDRESS: ,/€D
•
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: -
TELEPHONE NUMBER OF CONTACT PERSON �.- ?6
TAX MAP NO. : Section /CC Block Z Lot 3
tr
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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-‘1361. 21€1G
/ • Signature of Appl' ant
RECEIVED BY: Z - _/1�
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wn Clerk's fic
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DATE: - � Q
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