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JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK ` �O T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER %VA. 4 ,r
` Fax (516) 765-1823
,`j� �1�0.'•Jit � 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. 1013 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
ADD NEW OVERFLOW CESSPOOL TO SYSTEM AND FILL IN TWO OLD CESSPOOLS.
APPROVED AS SUBMITTED. REMOVE OLD COVER AND DOME. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner FOSTER, CLARA
Mailing Address 1 P. O. BOX 298
City St Zip MATTITUCK NY 11952
Property Address 1 251 HAMILTON AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 2 lot 5.000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 6/22/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY . : Town Hall, 53095 Main Road
TOWN CLERK .„ p T P.O. BOX 1 179
REGISTRAR OF VITAL STATISTICS �` �� Southold,Fax (516)New York 11971
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MARRIAGE OFFICER �,r ��0�t Pe ." Telephone (5 6) 765-1801
OFFICE OF THE TOWN CLERK ' r`,)! =', '
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office ToV'riv sl:01i40, ,.j
DATED: June 16, 1993
Transmitted herewith is a copy of application No. A1042 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Clara Foster ,
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 -
DISAPPROVE -
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OFFICE OF THE TOWN CLERK ,,,'"'"'""'--
Town of Southold � VOLI(
Judith T. Terry, Town Clerk ,' � Ci ` Application No. /a
Town Hall, 53095 Main Road t. Z Construction
P. O. Box 1179
Southold, New York 11971 t
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Alteration
its
Telephone $t.
$10.00 - Residential [/
(516) 765-1801 .� ���'��
- � ,, $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: /9-e--c---21711.--t-
APPLICANT
9-e--c---2J72-fhAPPLICANT ADDRESS: X6
SEPTIC CESSPOOL[/
DESCRIPTION OF PROPOS. De_ C NSTR.UCTION ALLTT,E,RATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION ORA TERATION:
OWNER OF PROPERTY: / ,11-/CA-
OWNER
-L4OWNER MAILING ADDRESS: 40 ' 8
OWNER PROPERTY ADDRESS: 2_ �'{� ' f,�--,r,,� , if .i jq-p
TELEPHONE NUMBER OF CONTACT PERSON: ..Z- �f� �
TAX MAP NO. : Section tit-e? Block 2-- Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
AL-1-16%7
(-17.
Signature of App cant
RECEIVED BY: kif ,
Town Clerk's Office
DATE: Cr`/&/y/" 4
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