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ELIZABETH A.NEVILLE �14, t� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS , � Southold, New York 11971
MARRIAGE OFFICER O ���1
t Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _-7®1 �s�, ole Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �l"
OFFICE OF THE TOWN CLERK
SOUTHOLD INASIVEMV.TERTEICEMDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2568 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 DEWS, JOSEPH
Mailing Address 1 PO BOX 1686
City St Zip SOUTHOLD NY 11971
Property Address 1 1170 NORTH SEA DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 5 lot 10.000
Cross Street KENNY'S ROAD
Building Permit Number Cross Reference:
Issue Date: 5/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
111
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ELIZABETH A.NEVILLE �� tc/
01",„' Town Hall, 53095 Main Road
TOWN CLERK k P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS 'N Southold, New York 11971
MARRIAGE OFFICER `�®�i ' x 01'0,01.
,, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =,_ ®� �®'ii 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: April 26, 2001
Transmitted herewith is a copy of application No. 2659 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Joseph Dews
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
1646
Dated
OFFICE OF THE TOWN CLERK ,��''6C��FF��ke+ Application No.016
TOWN OF SOUTHOLD '1 _Q y ,
ELIZABETH A.NEVILLE,TOWN CLERK V'
P.O.BOX 1179 ,}� Construction !/
SOUTHOLD,NEW YORK 11971o rr+ ; Alteration
triTelephone i f' $10.00 - Residential
(63•t) 765-1800 = 49
1' > �,��'� $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE �(A7
APPLICANT NAME:
APPLICANT ADDRESS: /_y- 972_
•
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
4-€./de-4c-e.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
• OWNER OF PROPERTY: 7 s 1�p1 e---te)s-
OWNER MAILING ADDRESS: a teog6
tet
OWNER PROPERTY ADDRESS: 1/7/) c 97m0Se4„.•
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 5-4 Block 5- Lot /d
GROSS STREET•
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of ; .plicant
RECEIVED BY:
Town Clerk's Office
DATE:
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DEWS
1170 NORTH SEA DRIVE
SOUTHOLD