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ELIZABETH A. NEVILLE �0 � Town Hall, 53095 Main Road
TOWN CLERK oD P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER `% o ���1/, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � �®/ ss22, ®��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �Ls' �/'�
OFFICE OF THE TOWN CLERK
SOUTHOLD WASITII SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2567 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 YACCARINO, MR.
Mailing Address 1 21605 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 21605 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 108.00 block 3 lot 11 .000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 5/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ��� \`
Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
y® Southold, New York 11971 e �`
REGISTRAR.OF VITAL STATISTICS
MARRIAGE OFFICERa65° 0,„ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ®1 �� iii 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. 2658 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Mr. Yaccarino
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 d ( o i
Dated
OFFICE OF THE TOWN CLERK � ��I D�K 9
TOWN OFSOUTHOLD �.�'o9 �QGy-- Application No. a4
5-1
F1.i7ABETH A.NEVILLE,
P.O.BOX 1179 � Construction (�
SOUTHOLD,NEW YORK 11971 v r=e
cn �� Alteration
•Telephone %V. Q/.'/, $10.00 - Residential
(631) 765-1800 =�O1' ����
• ,> ���,Is $25.00 -Non--Residential
• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION,
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE ilL/o/
APPLICANT NAME:
APPLICANT ADDRESS: Po /7i-)C 9? Z
•
SEPTIC CESSPOOL I/
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: /4
•
OWNER MAILING ADDRESS: e-9,--/6.e)<- j��fru /L
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /0 Block C_.3 Lot /1
CROSS STREET: A yr-a)
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
•
Signat re of p icant
RECEIVED BY:
Town Clerk's Office
DATE:
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YACCARINO
21605 MAIN ROAD
CUTCHOGUE