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Town Hall, 53095 Main Road
� ,��� P.O. Box 1179
®� ��;ii Southold, New York 11971
JUDITH T.TERRY `-�.�, �� l FAX(516)765-1823
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 514 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 ONE OVERFLOW POOL TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. NOTE: EXCAVATION INSPECTION REQUIRED.
Name Of Owner SLEDJESKI, MARTHA
Mailing Address 1 354 NORTH ROAD
City St Zip GREENPORT NY 11944
Property Address 1 354 NORTH ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 44.00 block 4 lot 4.000
Cross Street ALBERTSON LANE
Building Permit Number Cross Reference:
Issue Date: 7/20/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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TOWN OF SOUTHOLD . 1 5. ,,tfi Town Hall, 53095 Main Road
�er';c ' '' a' P.O. Box 1179
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��o' Southold, New York 11971
JUDITH T.TERRY „Aj;i_ra1l' TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: July 14, 1989
Transmitted herewith is a copy of application No.A 527 for .a Cesspool/
Septic Tank Construction Permit submitted by:
Richard Magill D/B/A Peconic Cesspool for Martha Sledjeski ,
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE C f
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OFFICE OF THE TOWN CLERK 6UFFC"c/'4,;--
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Town of Southold � ,; Application No.,`j '
17
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ` i�cr) {. Construction
P. O. Box 1179 0.‘ Alteration
Southold, New York 11971
*l �� �" Residential
Telephone
(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 $
DATE -7/1Y41
APPLICANT NAME: ;j Lrj 4, / 6,'//(D &i/ le
APPLICANT ADDRESS: "/ ' , 777,
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
73„-zry--6 •
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALT/ RATION:
OWNER OF PROPERTY: -- F' /� . `
OWNER MAILING ADDRESS: 3 YL �--
a--Ai/o0
OWNER PROPERTY ADDRESS: 6 ,
TELEPHONE NUMBER OF CONTACT PERSON: i ', 1/
TAX MAP NO. : Section Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
‘‘‘.1"--1"1"/ t-/
Signature of Ap./cant
RECEIVED BY: Ai (
Town Clerk's Office
DATE: "/ 1 Y7G-