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ELIZABETH A.NEVILLE d . '1: Town Hall, 53095 Main Road
TOWN CLERK ; cza
- P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER \` �,L ���1�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_�'/®� 44 ��i� Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER �� g1 '
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2479 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner MAILLARD, STEVE
Mailing Address 1 4336 GRANBY WAY
City St Zip MARRITTA GA 30062
Property Address 1 2775 BRAY AVENUE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 9 lot 8.000
Cross Street PECONIC BAY BLVD
Building Permit Number Cross Reference:
Issue Date: 12/01/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE d *�:
Town Hall, 53095 Main Road
!” TOWN CLERK ti 2 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � �� Southold, New York 11971
MARRIAGE OFFICER : �i N.- Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �__ � �,f� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ �������
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 28, 2000
Transmitted herewith is a copy of application No. 2567 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Maillard
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:
Signature
ccNe Jc,o
Dated
1 � -
OFFICE OF THE TOWN CLERK ���•�,FFOLk
TOWN OF SOUTHOLD •e' c'J �'QG= Application No. Q16 7
Fi.i7ABETH A.NEVILLE,TOWN CLERK �• o ;4.41
► •
P.O,BOX 1179 4; Construction
SOUTHOLD,NEW YORK 11971 rn
�� Alteration
Telephone �,j- �Q •,••• $10.00 - Residential
(631-) 765-1800
"Wei s'�,,°'� $25.00 -Non-Residential
....00O
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE fi 2g v
APPLICANT NAME: Y -
APPLICANT ADDRESS: 972-
SEPTIC CESSPOOL d/
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:
OWNER MAILING ADDRESS: "44336 G6/7-y
,3A ,
OWNER PROPERTY ADDRESS: 7775
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section l' 24 Block 9 Lot CD F
r 4 i_y
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
i
Signature of Apra'cant
RECEIVED BY:
Town Clerk's Office
DATE:
11
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