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''' ''',0,'''S-,Ii,-' . P.O. Box 1179
/ �� s Southold, New York 11971
JUDITH T.TERRY ,- ,0 FAX(516)765-1823
''"`.rir F< 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. 556 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 OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED: EXCAVATION INSPECTION REQUIRED.
Name Of Owner ZAHRA, SALVIAN
Mailing Address 1 109-04 LEFFERTS BOULEVARD
City St Zip SOUTH OZONE PARK NY 11420
Property Address 1 BAYER ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 139.00 block 3 lot 22.000
Cross Street WICKHAM AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/17/89 Judith T. Terry
Southold Town Clerk
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/ A�®�'0•' P.O. Box 1179
_ Southold, New York 11971
.JUDITH T. TERRY "'" 'Jo° TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
October 10, 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. A570 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
• Peconic Cesspool for Salvian Zahra
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 - )c
DISAPPROVE - n
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r1,./ 01 Signature
Date
/9,52
•
- OFFICE OF THE TOWN CLERK COM tTown of tholdD
Judith T. Terry, Town Clerk � =Ct Application No. �'D
Town Hall, 53095 Main Road cn
Construction
P. 0. Box 1179
O Alteration
Southold, New York 11971 ,yam �- �- .
Telephone �! t Ntt•-�y Residential v
(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 '1/e01-
APPLICANT NAME:
APPLICANT ADDRESS: D. 9 2L
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: G� �f/litc� •
OWNER MAILING ADDRESS: /O —O y `✓
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ax-Fic--- n-S�
TAX MAP NO. : Section /4'39, Block 3 Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signa ure of Apalicant
RECEIVED BY:
Town Clerk's Office
DATE:
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