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Town Hall, 53095 Main Road
\ritti ��� P.O. Box 1179
`��,," Southold, New York 11971
JUDITH T. TERRY " TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 486 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 EXISTING POOL WITH NEW TYPE.
APPROVED AS SUBMITTED. CALL FOR INSPECTION AFTER EXCAVATION.
Name Of Owner WOLCZOK, JOHN AND MARYANN
Mailing Address 1 32 SIXTH AVENUE
City St Zip FARMINGDALE NY 0000
Property Address 1 SIGSBEE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 144.00 block 2 lot 15.000
Cross Street PECONIC BAY BLVD.
Building Permit Number Cross Reference:
Issue Date: 4/18/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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-- ----•W SOVTHOLD �' ;;`;,y,' Q Town Hall, 53095 Main Roac
�. P.O. Box 1179 •
—�-1 4- ��i�� Southold New York 11971
•JUDITH T. TERRY % "4w 0-ill TELEPHONE
TOWN CLERIC
REGISTRAR OF VITAL STATISTICS (516)765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
April 12, 1989
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A497 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for John and Mary Wol czok
•
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
* * * * * * * * * * * *
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I have reviewed the application and location map of the
above and make the following recommendation: project listed
APPROVE - X.
DISAPPROVE -
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Signature
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Date
FFICE OF THE TOWN CLERK 0
tSFFOG4
Town of Southold 0�� ,. -•
Judith T. Terry, Town Clerk -`'� ' Application No. r
Town Hall, 53095 Main Road �r .. :
P. Construction
O. Box 1179 ® g Alteration
Southold, New York 11971
Telephone st �4 Residential
(516) 765-1801 '"
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: ' r/ %
APPLICANT ADDRESS: j �; /
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: 775- ,�� „ f'f 4 1% //C
OWNER MAILING ADDRESS:.,
OWNER PROPERTY ADDRESS: j - S ,
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section/ 54 Block Lot /.5
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of App ant
RECEIVED BY: �. t22-c /
c G? P rk's Off ce •
DATE:
APR 12 1989
Segib Od I'm Meads
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