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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK •' ® � c P.O. Box 1179
REGISTRAR OF VITAL STATISTICS j �, U� ., y 8 : Southold, New York 11971
MARRIAGE OFFICER , r ��� Fax (516),765-1823
" ` �`' Telephone (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. 691 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
ADDITION OF ONE OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 10' SEPARATION. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner VANDER®'ECK, ROBERT
Mailing Address 1 2775 WEST CREEK ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 2775 WEST CREEK ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 5 lot 4.000
Cross Street WEST ROAD/CROSS ROAD
Building Permit Number Cross Reference:
Issue Date: 3/20/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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BLDG. DEPT. �� i�`F % zz �� Town Hall, 53095 Main Road
TOWN —SOsU T 10LD
®` , �,,&-_,11 130 PII Glei t Ni I'M P.O. Box 1179
--IV * '",•' Southold, New York 11971
JUDITH T. TERRY '"sir' s1TELEPHONE
TOWN CLERIC (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
March 14, 1991
To: Southold Town Code Enforcement 'Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A711 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Robert Vanderbeck .
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.
c
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - JC
DISAPPROVE -
COMMENTS: eo , ,. , c.,„. ,g CNA ' kk. c.Q , Q.. . .12 / 0-
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Signature
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OFFICE OF THE TOWN CLERK ���"""
Town of Southold es." ULA
Judith T. Terry, Town Clerk •�' �� r4;
Application No.
Town Hall, 53095 Main Road Construction
•
P. 0. Box 1179c=ir z `
Southold, New York 11971 w• �',' Alteration
Telephone -�G� �"•• $10.00 - Residential
(516) 765-1801 _ Ol � ,, °' $25.00 -Non--Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE (3 / /47,/
APPLICANT NAME: ""--C----8772,--2„---e., ' ,-
APPLICANT ADDRESS: 97 2
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:
OWNER MAILING ADDRESS: ,Z77-S-
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: C1 '-'9 -
TAX MAP NO. : Section 1/0 Block J Lot 7"
CROSS STREET: G ‘,4—te�.
BUILDING PERMIT NUMBER CROSS REFERENCE:
't9
,%/.,11Siture of Applicant
RECEIVE-D BY:
Town Clerk's Office
DATE: 'D/ •
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