HomeMy WebLinkAboutSupendock 1! \lf
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Town Hall, 53095 Main Road
tIr P.O. Box 1179
� �� . i! Southold, New York 11971
JUDITH T.TERRY `� II
�� 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. 529 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. ' MAINTAIN 10'0" SEPARATION BETWEEN POOLS.
MAINTAIN 2'0" ABOVE WATER TABLE. NOTE: EXCAVATION INSPECTION
REQUIRED.
Name Of Owner SUPENDOCK, MATHILA
Mailing Address 1 4025 CAMP MINEOLA ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 4025 CAMP MINEOLA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 125.00 block 5 lot 29.000
Cross Street KRAUSE ROAD
Building Permit Number Cross Reference:
Issue Date: 8/23/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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�. Town Hall, 53095 Main Road
? 4 '``' _' osr.0 P.O. Box 1179
�_�,� �� �� ,+ Southold, New York 11971
JUDITH T. TERRY "�,I1,P�°// TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD °
August 8, 1989 L�c�'
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A542 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Mathila Supendock
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 -
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Date
OFF'tE 'OAF THE TOWN CLERKOUr
Town of Southold 0� �V _-
J Town Clerk : Application No. s 35
•' Judith T. Terry, 1
Town Hall, 53095 Main Road ` ' .
Construction
P. O. Box 1179
p � � � Alteration
Southold, New York 11971 ,fit '0�
Telephone _Ol [ � Residential Z�
(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 $ pb�
DATE
APPLICANT NAME: i* / J 2'4,/, ' (Q -
APPLICANT ADDRESS: /te /5-27-le. l7 �-
SEPTIC CESSPOOL 4/
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:AA-A L.J- St-, a-7Z do C--4
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OWNER MAILING ADDRESS: 90, 2,5" e �d -� !moi'i'''1% 'a / it
OWNER PROPERTY ADDRESS: � — f
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /1,5 Block 5 Lot 2-9
CROSS STREET: it A 4- '
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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