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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 e ®�.,t, Fax (516) 765-1823
__��/® �� 0' 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. 1040 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 CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED DISTANCES FROM ADJACENT
WELLS AND PROPETY LINE; ALSO 2FT. ABOVE GROUND WATER. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner SHER, CLAUDE
Mailing Address 1 1480 OLD WOOD PATH
City St Zip SOUTHOLD NY 11971
Property Address 1 1480 OLD WOOD PATH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 87.00 block 1 lot 21 .000
Cross Street SOUTH HARBOR ROAD
Building Permit Number Cross Reference:
Issue Date: 8/26/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK Vii+ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS S. .�`' Southold, New York 11971
MARRIAGE OFFICER �® O 44V Fax (516) 765-1823
7- ��� ��®��! Telephone (516) 765-1801
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fkrir,.............„,OFFICE OF THE TOWN CLERK �, f >t »�TOWN OF SOUTHOLD 4,AUG 2 ® „>
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TO: Southold Town Building Department f�� 1/
FROM: Linda Cooper, Southold Town Clerk's Office �tl9r -"'I� r` e,.. ;
DATED: August 20, 1993 " "" ��`;r , J.,,1
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Transmitted herewith is a copy of application No. A1071 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Michael Sher
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 - `r ' t' � 11'4 } ,
DISAPPROVE -
COMMENTS: j/ L i � ' % L/d - ALV
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Signature
CY:7:6-A3
Date
OFFICE OF THE TOWN CLERK „ '"""
Town of Southold ,,
Judith T. Terry, Town Clerk
ol/y
40 . Application No: `O 1/
• Town Hall, 53095 Main Road ;� C ction
P. O. Box 1179 = Z
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Southold, New York 11971 ; Alteration
Telephone O��O` .41-/
/ $10.00 - Residential /0-
(516)
(5 6) 765 1801 _ .[ 00
$25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE glin(73
APPLICANT NAME: Ree.---zry//e.--C, 'i .
APPLICANT ADDRESS: 7�.
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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 CONSTRUCT4ON OR ALTER TON:
OWNER OF PROPERTY: CL
OWNER MAILING ADDRESS: ./X,,e) � Lr�`?,- Ag.•U ,
./f/- - //f77
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: e9E6PP 96fel)
TAX MAP NO. : Section Block LotBL ;
CROSS STREET: g-7 l �
BUILDING PERMIT NUMBER CROSS REFERENCE/4( .
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Signatu `- of Applicant
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RECEIVED BY:
Rirk's Office
DATE: AUG 2 0
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