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F uy Town Hall, 53095 Main Road
P.O. Box 1179
__ ��! Southold, New York 11971
JUDITH T.TERRY ~~ ®
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FAX���•�•1°" FAX(516)765-1823
TOWN CLERK TELEPHONE(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. 553 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. NOTE: EXCAVATION INSPECTION REQUIRED.
Name Of Owner WOZNICK, CHARLES
Mailing Address 1 BOX 44
City St Zip EAST MARION NY 11939
Property Address 1 ORCHARD LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 6 lot 26.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 9/29/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
71-_ 65-3 .
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�'{, s ` .•" 't,A Town Hall, 53095 Main Road
11;:b.,1' -. .&-) P.O. Box 1179
_ , Southold, New York 11971
JUDITH T. TERRY " / Oil° TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 26, 1989 C
SEP 2g quo
To: Victor Lessard, Southold Town Building Department
From: Linda J. Cooper, Southold Town Clerk's Office TOWWN ••FF''_®EPT,
•MOLD
Transmitted herewith is a copy of application No. A567 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for Charles Woznick .
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.
G cL"J
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - D`
DISAPPROVE -
COMMENTS: __meq, 071AQV... SIk.,-k.,_o.
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,,-.) Signature
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< Date
OFFICE OF THE. TOWN CLERK COFOUr
Towri- of Southold Ci �
Judith T. Terry, Town Clerk Application No. ,-)(0 7`
Town Hall, 53095 Main Road ` g Construction
P. 0. Box 1179 n 'r" 't
Southold, New York 11971 � ® �'"4 / Alteration
Telephone Olimg 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 $ /0i /It) (716/
DATE 463
APPLICANT NAME: '°_/fd - /-e
APPLICANT ADDRESS: /9.-(9 ��
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
cro--e-Npecri,v-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTI N OR ALTERATION:
OWNER OF PROPERTY: .E� .�� "6Z) 111
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: � air--e2-"-4-04
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 2 / Block t Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Xe4C/14 /
Signature o Applican
RECEIVED BY:
Tiair '^k's Office
•
DATE: SEP 2
To Clerk Southold
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