HomeMy WebLinkAboutSimonson JUDITH T. TERRY ATown Hall, 53095 Main Road
TOWN CLERK ® t;
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER C) *4' 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. 836 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 POOL TO AN EXISTING SYSTEM-.
APPROVED AS SUBMITTED. HOLD 10' SEPARATION. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner SIMONSON, NELLIE
Mailing Address 1 STROHSON ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 STROHSON ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 10 lot 31 .002
Cross Street BALDWIN ROAD
Building Permit Number Cross Reference:
Issue Date: 5/11/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY . Town Hall, 53095 Main Road
TOWN CLERK r` oi P.O.tai Box11_,
Southold,gr2sNew 971
REGISTRAR OF VITAL STATISTICS ���` Fax (516) 7
MARRIAGE OFFICER % ® .�
" -.% ,ss zz, *it
- Telephone (516801
OFFICE OF THE TOWN CLERK -
TOWN OF SOUTHOLD IQ
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MAY 5, 1992 ( I NAY 51992,
To: Southold Town Code Enforcement 'Officer TOWNg I;)k-- '''''--- i
From: Linda J. Cooper, Southold Town Clerk's Office i
Transmitted herewith is a copy of application No. A860 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for NELLIE SIMONSON .
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 - JC
DISAPPROVE - LICA
4COMMENTS: o,,, J.-v,_J.-v,_Gd„Got _c M c 1a cl/�Lg of , `a."�io
..., 14),..2. .4%Ai 5 i..4.4 TA ctieug, --C,4"...j holet 1 01- tgfouLot:4,4
RECEIVED
r�� MAY 07 if-- 1
TOWm Clerk Southold
. .\(c.e.11-t. Cia-.. °LAI
�� Signature
c'° Date
OFFICE OF THE TOWN CLERK ,,'",,""'-
Town of Southold .''a',IFOL/(e' _ QJ�
Judith T. Terry, Town Clerk ��' �/y Application No. ° `�)
Town Hall, 53095 Main Road ; Construction
P. 0. Box 1179 Apr rn ;
Southold, New York 11971 •ttl �,� Alteration
Telephone y0,� Qom.,' $10.00 - Residential
p W �
(516) 765-1801 =��1 ' $25.00 - Non-Residential
• --- . ..011°
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: - -
APPLICANT ADDRESS: 1S 4394977,
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
..;ge 67-26-1/47-7._
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION `OR j4LTER�ITION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
-paw, ecti-
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section in Block /d Lot CS
CROSS STREET: � '- � _ _,_ A.— - ,' -de/Wilt/1V
ilt1/V -
BUILDING PERMIT NUMBER CROSS REFERENCE:
(.„4_,„"1":
Signature of At•if c nt
./
RECEIVED BY:
Town Clerk's Office •
DATE: -
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