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JUDITH T. TERRY ; I •
Town Hall, 53095 Main Road
TOWN CLERK ` T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER l® c , Fax (516) 765-1823
+ �1�••I Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1055 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
ADDITION OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED DISTANCES FROM ADJACENT
WELLS, BUILDINGS AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner WRIGHT, JOHN F.
Mailing Address 1 BRAY AVENUE
City St Zip LAUREL NY 11948
Property Address 1 BRAY AVENUE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 9 lot 12.000
Cross Street PECONIC BAY BLVD.
Building Permit Number Cross Reference:
Issue Date: 10/28/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL
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JUDITH T. TERRY . Town Hall, 53095 Main Road
TOWN CLERK Z ® r , P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS if, �` Southold, New York 11971
d° +% Fax 516 765-1823
MARRIAGE OFFICER "" ® r ( )
,y®1 �1D0•0 Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK _
TOWN OF SOUTHOLD ll�ti --�_ _
TO: Southold Town Building Department �',�
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FROM: Linda Cooper, Southold Town Clerk's Office 2 i ,. OST B 81993 ,,,
DATED: October 15, 1993 ¢} x`
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Transmitted herewith is a copy of application No. A1086 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Peconic Cesspool for John F. Wright .
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 - EXCAVOON INSPECT I
DISAPPROVE - .EWJ RED
COMMENTS: ' 12.!:210/7‘.e...."). ,t G2 ry, ,
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' 0.F F I CE OF THE E TOWN CLERK ,,,,,,,,, P
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Judith T. Terr ,
l y Town Clerk 1,��'�40 6l/ Application No.
Town Hal , 53095 Main Road ; . Co n
P. 0. Box 1179
Southold, New York 11971 •ttJ' n��� Alteration
Telephone -y0,j%y #../ $10.00 - .- ial v
(516) 765-1801 = Ol $, s' $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 /d /VR5
APPLICANT NAME: ` .C� `'; i...l . /
APPLICANT ADDRESS: /C/ '2_,
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SEPTIC CESSPOOL
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DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 4
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST RU TION OR ALTERAT4I IO :
OWNER OF PROPERTY: tf/
OWNER MAILING ADDRESS. tilt) C•
OWNER PROPERTY ADDRESS: •
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /24 Block 9 Lot /Z._
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signatr/e of Applicant
RECEIVED BY: ,,'5'. e;c0.,,ia j
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• ��wown Clerk's Office -
DATE: 001 L 1V
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