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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘Fa Southold, New York 11971
MARRIAGE OFFICER O ®.
Fax (516) 765-1823
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(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1090 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECON I C CESSPOOOL
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 DISTANCE FROM ADJACENT
WATERBODIES, WELLS, BUILDINGS AND PROPERTY LINES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner STRONG, DAVID
Mailing Address 1 P. O. BOX 1033
City St Zip MATTITUCK NY 11952
Property Address 1 1130 WICKHAM AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 2 lot 6.000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 1/28/94 Judith T. Terry
Southold Town Clerk
(TOWN SPA( 1
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JUDITH T. TERRY ; ..< Town Hall, 53095 Main Road
TOWN CLERK ,1 ® T P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS , in .w ,z Southold, New York 11971
�`�ti��?MARTtT CER r, ----462
Q` ��� Fax (516) 765-1823
g�r 11;._ "! �„, r., 4 'E _ 4 7 Ak �1Iy® �. Telephone (516) 765-1801
l i f' JAN 9 91994 6 'l
OSOFFICE OF THE TOWN CLERK
I •�;:c:`- ,} TOWN OF SOUTHOLD
91w1N OF sou rriow _�.a
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: January 18, 1994
Transmitted herewith is a copy of application No. A1125 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for David Strong ,
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: �pq�
APPROVE - /..-, EXCAVATION INSPECTION
REQUIRED
DISAPPROVE -
24 4 COMMENTS: % re,. rJ � �
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Date
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OFFICE OF THE TOWN CLERK „ ''
Judi Town of Southold ���•''o�� VOUrtn; Application 110'. f )�
Judith T. Terry, Town Clerk , y
Town Hall 53095 Main Road $�M• = Construction = -•'
P. O. Box 1179 . = «-• ' - 'c :
v :, ^' Alteration i___--------
Southold, Nev York 11971 •tri :�$
Telephone `y�,�''0 - ' ,.C” .4 $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 $ •
DATE 1 / / / ?9Y
APPLICANT NAME: .�/�,.,
ie," ,,,., 4
..
APPLICANT ADDRESS: f1 f7z
SEPTIC CESSPOOL L..--
DESCRIPTION
-
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: _0 /
OWNER MAILING ADDRESS: 4014 /0) 33
33
OWNER PROPERTY ADDRESS: /l,,?60 iJt� ��,, �joe-c.
TELEPHONE NUMBER OF CONTACT PERSON: M-------YC
TAX MAP NO. : Section ././ .,46) Block 7' Lot
CROSS STREET: q ' 7
BUILDING PERMIT NUMBER CROSS REFERENCE:
! , / e ////
7
Signature o Applic.
RECEIVED BY: ,/ / / Y
To n Clerk's Office
DATE: // F5-f ?)G
/
411 3.54
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