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JUDITH
JUDITH T. TERRY AT -4" Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�.
Southold, New York 11971
MARRIAGE OFFICER eta. 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. 842 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
REPLACE OLD CESSPOOL WITH NEW TYPE TO EXISTING SYSTEM.
APPROVED WITH STIPULATIONS. REMOVE EXISTING CESSPOOL AND 5' OF SOIL A
AROUND OUTSIDE OF CESSPOOL RING. REPLACE WITH CLEAN SAND. CALL FOR
EXCAVATION INSPECTION.
Name Of Owner THOMPSON, THORVALD
Mailing Address 1 743 54TH STREET
City St Zip BROOKLYN NY 11220
Property Address 1 675 WELLS ROAD
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 8 lot 21 .000
Cross Street BRAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/28/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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A! *� , 1`i , MAY 2 71992 i 1
JUDITH T. TERRY j '\ w Town 11a11; 53095 Main Road
TOWN CLERK s ® �v -_= _ -=—=_ 0. BOX 1179
REGISTRAR OF VITAL STATISTICS C0 .l�" Southold, New York 11971
TOWN fi �,
MARRIAGE OFFICER '�® ��,`` -------°�-- t'--'±=Fax (516) 765-1823
® �! Telephone (516) 765-1801
.../
OFFICE OF THE TOWN CLERK _
TOWN OF SOUTHOLD
May 27, 1992
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A 871 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Thorvald Thompson
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: `,/'9k
Ilk
APPROVE - >` T, '�•J Q
DISAPPROVE - S'p .
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�° • Signature
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Date 1
s 7/7.-/
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OFFICE OF THE TOWN CLERK '1`%''"" �•y
Town of Southold •' c�F Application No. D.117/
Judith T. Terry, Town Clerk
_
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Town Hall, 53095 Main Road � � Z �� 1 Construction
P. 0. Box 1179 • _ _ '
='` A- rn Alteration
Southold, New York 11971 p to •. t
TeleTelephone y,�' $10.00 - Residential
p `a
(516) 765-1801 Ol ' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for
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\,CONSTRUCTION or ALTERATION PERMIT
CSEPTIC TANK orCESSPOOL
Permit No.
Fee $
DATE 042„)
APPLICANT NAME:
v
APPLICANT ADDRESS: �/'✓(Jz, 92z
SEPTIC CESSPOOL
DESCRIPTION 0 PROPOSED CONSTRUCTION OR ALTERATION
V..1•71,2,'CLZon.,
®-C'1 17/ 6 c9-4f 5 1. 7_
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST • UCTION OR ALT . RATION:
OWNER OF PROPERTY: ' " ; /-/ / a
OWNER MAILING ADDRESS: A1-6-77—
' OWNER PROPERTY ADDRESS: " '
TELEPHONE NUMBER OF CONTACT PERSON: r~� Y
TAX MAP NO. : Section / 24 Block ' Lot 2-7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:. '
�'— nature of Applicant
•
RECEIVED BY: ,
o n/ Clerk's O fice
DATE: - ' � '1-�7
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