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JUDITH T. TERRY L Town Hall, 53095 Main Road
TOWN CLERK' P:O. Box 1179
REGISTRAR OF VITAL STATISTICS U' �� Southold, New York 11971
MARRIAGE OFFICER „N- Fax�• Fax (516) 765-1823
® i Itw, e. 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. 1004 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESPOOL
Address 1 : P. O. BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF NEW OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. KEEP 10' APART. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner SHER, MICHAEL
Mailing Address 1 43 RIDGE ROAD
City St Zip SEARINGTON NY 11507
Property Address 1 1480 OLD WOOD PATH
(1250 SMITH ROAD)
City St Zip SOUTHOLD NY 11971
Tax Map No. section 98.00 block 3 lot 26.000
Cross Street HARBOR ROAD
Building Permit Number Cross Reference:
Issue Date: 5/25/93 Judith T. Terry
Southold Town Clerk
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1, I I MAY 2 41993 ' o°f SI' '4-
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JUDITH T. TERRY �- _, . - 9, :- Town Hall, 53095 Main Road
I int6 = 3 P.O. Box 1179
TOWN CLERK TOM Err'coir loin c=irTi Ai
-
ST '}' u „ , Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �"”' ^"���f:�:k., .�_�,. y �� Fax (516) 765-1823
MARRIAGE OFFICER ® ®� i
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Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 24, 1993
Transmitted herewith is a copy of application No. A1032 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 -
DISAPPROVE -
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COMMENTS:
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OFFICE OF THETOWN CLERK ,,'""'"" •
Town of Southold �."��C, VULK('�
Q Application No. A---1 6,3 aJudith T. Terry, Town Clerk „`' Gy
Town Hall, 53095 Main Road % . . Construction
P. O. Box 1179 ; coil,'
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iSouthold, New York 11971 oOf Alteration
Telephone
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�Q , $10.00 - Residential C.,.(516) 765-1801 ----_44:01 �/v'l $25.00 - Non-Residential
TOWN OF SOUTHOLD
1
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
,
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE '-c41/9/3
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APPLICANT NAME: -ee '' �j , • --/- '
APPLICANT ADDRESS: v h / gr 72
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SEPTIC CESSPOOL v
DESCRIPTION OF PROPOSED CONSTRUCTION.OR ALTERA !N
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUC ION OR LT RATION:
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OWNER OF PROPERTY: / 2' ,.. ,- ff
OWNER MAILING ADDRESS: 413 6���- /�.�
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OWNER PROPERTY ADDRESS:
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TELEPHONE NUMBER OF CONTACT PERSON: ,
TAX MAP NO. : Section Fa( Block 3 Lot =_
CROSS STREET: /41-1- - fie-v- - �. -
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Apv cant
RECEIVED BY:• — .
- •
To n Clerk's Office = -
DATE: RAVED - -MAY 2 41993 - -
Town Clerk Southold
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