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Town Hall 53095 Main Road
?� �4 P.O. Box 1179
'__ `� 00 Southold, New York 11971
JUDITH T.TERRY ® �a FAX(516)765-1823
TELEPHONE(516)765-1801
TOWN CLERK
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. 559 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 AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. NOTE: EXCAVATION INSPECTION REQUIRED.
Name Of Owner WOOD, DOROTH AND PAUL
Mailing Address 1 665 BAYSHORE ROAD
City St Zip GREENPORT NY 11944
Property Address 1 665 BAYSHORE ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 53.00 block 4 lot 20.000
Cross Street ISLAND VIEW LANE
Building Permit Number Cross Reference:
Issue Date: 10/20/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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` ,%,17...,1 ,i, , Town Hall, 53095 Main Road
TOWN OF SOUTHOLD �.wa, ,C:"r ` ?. ,: P.O. Box 1179
�� °s :` y� Southold, New York 11971
JUDITH T.TERRY . ..Amy,- TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: October 16, 1989
Transmitted herewith is a copy of application No. A 573 for a Cesspool/
Septic Tank Construction-- Permit submitted by:
Peconic Cesspools For Dorothy & Paul Wood .
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
• may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
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I have reviewed the application and location map of the project cited above
and make the following recommendations: .
APPROVE aC
DISAPPROVE
Comments: Ci.; LAn_ c_saltz A w,,, a .1C.g ►
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Signature
at"' 7•1 k‹\11\1°\'
�. Dated
OFFICE OF THE TOWN CLERK ,C0FU(,r
Town of Southold .
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Town Clerk Application No1�
Judith T. Terry,
Town Hall, 53095 Main Road U-3 Construction
P. 0. Box 1179
Southold, New York 11971 ,y� %)\#;°''' Residential
Alteration
Telephone �l [ �� 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 /rte le k
APPLICANT NAME:
APPLICANT ADDRESS: / -d '7
SEPTIC CESSPOOL
DESCRIPTIONO'F PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: GG ��
OWNER MAILING ADDRESS: 5 jZ e.
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section c_5-3 Block 4 Lot c:
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Ap.-'cant
RECEIVED BY:
Town Clerk's Office
DATE:
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