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JUDITH T. TERRY �4' Town Hall, 53095 Main Road
TOWN CLERK v P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ® [�y Southold, New York 11971
MARRIAGE OFFICER = �? Fax
x (516)
6)(5 765-1823765
1801
600
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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. 741 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
REPALCE EXISTING POOL WITH NEW TYPE.
APPROVED AS SUBMITTED. CALL FOR NECESSARY EXCAVATION INSPECTION.
Name Of Owner WILLIAMS, JEFFREY
Mailing Address 1 P. O. BOX 463
City St Zip SOUTHOLD NY 11971
Property Address 1 1445 BAY AVENUE
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 9 lot 7.003
Cross Street MAIN ROAD (S.R. 25)
Building Permit Number Cross Reference:
Issue Date: 7/26/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
1.
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JUDITH T. TERRY ��� Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK
REGISTRAR OF VITAL STATISTICS Southold, New fork 11971
• p E OFFICER �` Fax (516) 765-1823
t`C ,;, ��r Telephone (516) 765-1801
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991 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
BLDG DSpT
SOWN OF SOUTlOLO July 19, 1991
To: Southold Town Code Enforcement 'Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No.4 763 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Jeffrey Williams
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 ,''ire%FF0Lk' = Application No. 7 !off
Judith T. Terry, Town Clerk ,' y
Town Hall, 53095 Main Road � = Construction
P. 0. Box 1179 rrt �
Southold, New York 11971 •to �, Alteration
Telephone 4 ,re $10.00 - Residential ` fl
(516) 765-1801 = 1 ', '' $25.00 -Non-Residential
• '''
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER 'DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. -i Co,
Fee .$lam
DATE 7/ir/f/
APPLICANT NAME: /st1jz_ �:✓r-��
APPLICANT ADDRESS: / 'd 6,erf
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTIQN OR ALTERATION
we'/ BLit= _ i'e,L/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: "
OWNER MAILING ADDRESS: , 44:a,
OWNER PROPERTY ADDRESS: .�l�st15 /1 ‘ "-
TELEPHONE NUMBER OF CONTACT PERSON: °--99-'-' 765V
TAX MAP NO. : Section 3/ Block "' Lot .71r 3
CROSS STREET: T2s
BUILDING PERMIT NUMBER CROSS REFERENCE:
- - d
A9,41
Sign ure of Applicant
RECEIVED BY: g t
own Clerk's Office •
DATE: / 9/q7
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