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ELIZABETH A. NEVILLE �� : Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS 1,t Southold, New York 11971
MARRIAGE OFFICER � y �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER = ®s®,l ��®���� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �.���� •1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2524 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner WOLBERT, JAMES & LINDA
Mailing Address 1 PO BOX 558
1480 WEST MILL ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 20905 ROUTE 48
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 96.00 block 1 lot 4.001
Cross Street TUTH I LL ROAD
Building Permit Number Cross Reference:
Issue Date: 3/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
41100„. 101"
OFFOlit
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ELIZABETH A.NEVILLE �� ��: Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS °PY Southold, New York 11971
MARRIAGE OFFICER � �It' Fax (631) 765-6145
Wi•RECORDS MANAGEMENT OFFICER =_ ®� . • it°i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
mos���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 8, 2001
Transmitted herewith is a copy of application No. 2612 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Peconic Cesspool for James &Linda Wolbert
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
`3 g% I
Dated
•
"ice.
E1 OF THE TOWN CLERK ,0.''c001.1(0,--__
TOWN OF SOUTHOLD /�, GApplication No. '12/61 /
ELIZABETH A.NEVILLE,TOWN CLERK �� 0 '�►
P.O.BOX 1I79 i ; Construction I/
SOUTHOLD,NEW YORK 11971 o rn Alteration
Telephone �y�,jg, �Or/ $10.00 - Residential- - i,,/
(631) 765-1800 Ol' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION - -
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit•'No. - - ' • •
Fee •$ -
DATE ` al- / ,,
APPLICANT NAME: P.09-e-4/ ' eeta-foterk-ii
APPLICANT ADDRESS: eo /15-0X, 972_,
i'/20
SEPTIC CESSPOOL 1-'"
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONS ' UCTION OR ALTERATION:
- - OWNER OF PROPERTY: __", ta)'66-12-tt"
OWNER MAILING ADD; / Lk (it),Rid± L ./
OWNER PROPERTY ADDRESS: �90s -0.--X- i' / f
. ________4„... ...d.„.e.
TELEPHONE NUMBER OF CONTACT PERSON: afr:=%,s-e
TAX MAP NO. : Section q6 : Block I Lot 4, / •
CROSS STREET:
7A-4411 etce
BUILDING PERMIT NUMBER CROSS REFERENCE: ,
Signature of pplicant - "_- • _
RECEIVED BY: be " -
TownWo
Clerk's Office
DATE: 3
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J arn't.',3 8:: Linda Wrilbeil.
20905 Route 4S'
Cutchogue, New York