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JUDITH T.TERRY • Town Hall, 53095 Main Road
TOWN CLERK g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS �1, Southold,New York 11971
MARRIAGE OFFICER �� �`.,4- Fax(516)765-1823
RECORDS MANAGEMENT OFFICER ®i i /�i� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ~„„ ,,s”
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1200 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PEOCNIC CESSPOOL
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 SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner TOAN, ETHEL G.
Mailing Address 1 P. O. BOX 531
City St Zip SADDLE RIVER NJ 7458
Property Address 1 360 RUCH LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 52.00 block 2 lot 22.000
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 9/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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.IUDITH T. TERRY �, __ O Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
. Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 1 �1` Fax (516) 765-1823
MARRIAGE OFFICER 1.10. .1
Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER - ��
FREEDOM OF INFORMATION OFFICER ,� iiii���
OFFICE-4.-0-4-'71n: TOWN CLERK p � ( p
TOWN OF SOUTHOLD I
TO: Southold Town Building Department SEP `''�• ��
FROM: Linda Cooper, Southold Town Clerk's Office i -
SLDG.DEPT.
DATED: September 2, 1994 TOWN OF SOUTHOLD '
Transmitted herewith is a copy of application No. !1245 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Ethel G. Toan
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.
xu
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - ®�n
DISAPPROVE - C0514401.7°)
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Signatur•-
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Date
OFFICE OF THE TOWN CLERK ,'" •
Town of Southold .''"citFWire�
Judith T. Terry, Town Clerk ��� �� . �" Gy�; Application NA I al-45
Town Hall, 53095 Main Road � e ) `
Construction
P. 0. Box 1179
Southold, New York 11971 I Alteration
Tele hone 0 / $10.00 - Residential !/
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IP
(516) 765-1801 "1 , '1 $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT •
RECEIVED
APPLICATION SEP 2 1994
for Town Clock Southold
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. .
Fee $
DATE �F ! ?91
APPLICANT NAME: f �
APPLICANT ADDRESS: , ei ,J�
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: L5.-77/81/ iri c '11 �Y/✓
OWNER MAILING ADDRESS: /j/ /%y S3/ 5"/WW.fr
OWNER PROPERTY ADDRESS: .. 6® A tie, A LA-4/
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TELEPHONE NUMBER OF CONTACT PERSON: L9 9'' $
TAX MAP NO. : Section '-', Block 2— Lot 2-1--
CROSS STREET: Aer.
BUILDING PERMIT NUMBER CROSS REFERENCE:
AC/../ -/
Signatur= .f Applicant
RECEIVED BY: _ `Ai._//
•wn Clerk's Office
DATE:
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SEWER& DRAIN SERVICE
P 0. BOX 972 BRAY AVENUE MATTITUCK, NEW YORK 11952
(516)298-9658
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