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OFFICE OF THE TOWN CLERKc5�FFU(Ir`," •
Town of Southold �� -
Judith T. Terry, Town Clerk
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Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 O�-��`
Telephone Ol * '
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 74 Residential XX
Fee $ 10.00 Non-Residential
Septic Cesspool xx
PERMIT ISSUED TO:
NAME: Valentine J. Pust
ADDRESS: 1587 Sycamore Avenue
North Merrick, New York 11566
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New single family dwelling with septic system
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
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OWNER OF PROPERTY: Valentine J. and Erika J. Pust
OWNER MAILING ADDRESS: 1587 Sycamore Avenue
North Merrick, New York 11566
OWNER PROPERTY ADDRESS : Middle Road (C.R. 48)
Peconic, New York
TAX MAP NO. : Section 74- Block 2 Lot 12.2 .
CROSS STREET: Mill Road
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
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Judith T. Terry
Southold Town Clerk
DATE: August 28, 1986
(TOWN SEAL)
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OFf ICE OF THE TOWN CLERK
Town of Southold
Application No.c)?
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Alteration
Southold, New York 11971
Telephone Residential L-
(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 $ /L)
DATE
APPLICANT NAME: e:L ie/4 JIi1 c'J / i,t3
APPLICANT ADDRESS: /S ?'7Ili �J,'�e Ave-,
ave-71-4 �S�lC�rief9tic.16 / ( „s-
SEPT I C 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:
, / ) J � "F5
OWNER OF PROPERTY: 1/14)7 4,4 �` tea , i S f
OWNER MAILING ADDRESS: /3.-6'7 5/6,,,i1G7,2e j'f &;
/A.* "'")061 a/( At/ //���
OWNER PROPERTY ADDRESS: ;d // Rd. <C.g, Lt 6> " r
7/.,5'
7/,.,x' 1:=/) ,%/ )cif
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TELEPHONE NUMBER OF CONTACT PERSON: ,375
r $ 7
TAX MAP NO. : Section O7" Block Z Lot Li-, Z
CROSS STREET: A. R&,
BUILDING PERMIT NUMBER . CROSS REFERENCE:
,-57),�� E'f�i •' _0/ 2
Signature of Applicant
RECEIVED BY:e4 ei�c cC v �
Town Jerk's Office
DATE: '�� 6 < /Ie
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