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JUDITH T. TERRY Town Hall, 53095 Main Road
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TOWN CLERK a P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER c� O ���' Fax (516) 765 1823
/y2 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. 791 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
ADDITON OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10'0 SEPARATION AND CALL FOR EXCAVATION
INSPECTION.
Name Of Owner SMITH, CATHERINE
Mailing Address 1 1520 BRAY AVENUE
City St Zip LAUREL NY 11948
Property Address 1 1520 BRAY AVENUE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 7 lot 27.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 1/07/92 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY ��� rye" Town Hall, 53095 Main Road
, ` _ ,,,�,. ,,,,„,, �; P.O. Box 1179
TOWN CLERK 4 �x
REGISTRAR OF VITAL STATISTICS N �u It, Southold, New York 11971
MARRIAGE OFFICER - �$��� Fax (516) 765-1823
� • Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
RECEIVED
December 27, 1991
AN 02 Inn,)
To: Southold Town Code Enforcement Officer
Town Clerk 'ill ~ ,
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A812 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Catherine Smith
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 - X
DISAPPROVE -
COMMENTS: A ( 0, 4 . ' -�
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Signature
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Date
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OFFICE OF THE TOWN CLERK �,c�'""""'%,
Town of Southold �,• ;1fI A-i _ / 2----
Judith
Judith T. Terry, Town Clerk' ,�� >," ' .. G"
Application No.
Town Hall, 53095 Main Road ;�� � - Construction e..--------
P.
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P. O. Box 1179 `
v If `.,. '-r' 1 Alteration
Southold, New York 11971 ;ct� 1.`
Telephone `y0 ' , .°V'�•� $10.00 - Residential
(516) 765-1801 = 1 ,, ' $25.00 - Non-Residential '
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. =
•
Fee $ � ;1
DATE 117/11 V 1
APPLICANT NAME: ,,~77'e-r---2 / /
APPLICANT ADDRESS: /3 972
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ,R
OWNER MAILING ADDRESS: /5-7---0 .
"Z", '/ 9cer
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 69-57— �� 57--
TAX
7'TAX MAP NO. : Section / 2'6° Block 7 Lot 7
r
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
27.i....c.....‘,6_,_c___ve i //
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
'' DATE: __
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