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ELIZABETH A.NEVILLE �I .k Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS +�� Southold, New York 11971
MARRIAGE OFFICER # C� �$ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � �®� s2 � le Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER ' l
OFFICE OF THE TOWN CLERK
SOUTHOLD INASECIIIMMERTHEERIDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2617 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONCI 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 DUPRE, HENRY
Mailing Address 1 PO BOX 1460
City St Zip CUTCHOGUE NY 11935
Property Address 1 1460 STROHSON ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 10 lot 29.001
Cross Street BALDWIN ROAD
Building Permit Number Cross Reference:
Issue Date: 7/24/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE �� 0,t + ��: Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
,
REGISTRAR OF VITAL STATISTICS 16 �� Southold, New York 11971
MARRIAGE OFFICER � e Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_�®,� ��®ii� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
.. .01ir/�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 3, 2001
Transmitted herewith is a copy of application No. 2705 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Henry Dupre
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
*lo
Dated
t ^ -, . Town Of Southold
P.O Box 1179
�'� Southold, NY 11971 '
* * * RECEIPT * * *
Date: 07/03/01 Receipt#: 5704
Transaction(s): Subtotal
1 Septic Permit-Construct- Resid. $10.00
Check#: 5704 Total Paid: $10.00
Name: Peconic, Cesspool
P O Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID:35902
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OFFICE OF THE TOWN CLERK
TOWN OF SOUFHOLD •l• c'J��F�LKCQG:� Application N927a
ELIZABETH A.NEVILLE,TOWN CLERK �'
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971
PT
• •� Alteratio
Telephone YO,y �Q��••, ., - $10.00 ='Residential f/
(63t) 765-1800 =�01' �• $25.00 -Non--Residential
• •.••••••00
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. -
Fee •$
DATE 74/0 /
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952 '
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION O ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: //trine y, 00/0 e
OWNER MAILING ADDRESS: O90 / ij /1,Z601
OWNER PROPERTY ADDRESS: /Y61, STh ovissf42
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /0_3 Block /0 Lot c9-9• •
CROSS STREET: ,V J2 at
BUILDING PERMIT NUMBER CROSS REFERENCE:
440C/06 moi' /
Signature •ilApplicant -
•
RECEIVED BY: '
To n CI rk's Office
DATE: 77 G(
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