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ELIZABETH A.NEVILLE �"'Pe �tltl �, � Town Hall, 53095 Main Road
TOWN CLERK PO. Box 1179
REGISTRAR OF VITAL STATISTICS �,
� � �;, Southold, New York 11971
MARRIAGE OFFICER :� # ' - ��,g Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER --_ ,�D $ ��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
SOUTHOLDIMURIVREIRIIII3IFEDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2595 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 975
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 JAMES & CINDY KAMINSKY
Mailing Address 1 52 WOODCLIFF DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 100 EAST MILL ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 4 lot 4.000
Cross Street GRAND AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/30/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
if' OFFatir
ELIZAEETH A.NEVILLE ��� �� Town Hall, 095 Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t Southold, New York 11971
MARRIAGE OFFICER . O cs:V � Fax(631) 765 6145
/
RECORDS MANAGEMENT OFFICER �i%/ ,s� �,=iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `I ,i'�
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 25, 2001
Transmitted herewith is a copy of application No. 2683A for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Kaminsky
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:
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Signature
c a-s 1O l
Dated
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OFFICE OF THE TOWN CLERK ,,°, CFFOLkC� �
TOWN OF SOUTHOLD �t•% �'QG=. Application NoDAP
ELIZABETH A.NEVILLE,TOWN CLERK i y� L,
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SOUTHOLD,
BOX 1179 :
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JAMES & CINDY KAG[NSKY
100 EAST MILL ROAD
MATTITUCK
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