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ELIZABETH A.NEVILLE �1 � Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Ny Southold, New York 11971
MARRIAGE OFFICER :4 O � �1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �® V®.. Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ED �'�
OFFICE OF THE TOWN CLERK
SOUTHOLD liNginiagarrarlatSRDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2566 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 CHRISTIE, JOHN
Mailing Address 1 PO BOX 1026
City St Zip SOUTHOLD NY 11971
Property Address 1 250 MIDWAY ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 90.00 block 1 lot 9.000
Cross Street
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 ; coP.O. Box 1179
t
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER `� `�� f1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = ® �'22 � ' �i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER • `zs' ,D"
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. 2657 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for John Christie
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.
ignature
Dated
OFFICE OFTHE TOWN CLERK , .so��FfO(K�+►Ol/ Application No a�s 7
TOWN OF SOUTHOLD ,�' y
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 z1FO _; Construction
SOUTHOLD,NEW YORK 11971 t
v • ^' Alteration
Telephone O,y - - Q7/ $10.00 - Residential
(631-) 765-1800 = at' $ 00' $25.00 -Non--Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE itic/o/
___ „ , , 1
APPLICANT NAME: l/
APPLICANT ADDRESS: 4Rf /,,'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
r.71.04) /iv, i - ,( 77-: 7 Sra-- -,--)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OI ALTERATION:
OWNER OF PROPERTY: ems . _'.
OWNER MAILING ADDRESS: ./Q4/ /(22
OWNER PROPERTY ADDRESS: (5S0
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block '1 ZF Lot iv9
CROSS STREET: —�
BUILDING PERMIT NUMBER CROSS REFERENCE:
i44(4
Signature pplicant
RECEIVED BY:
Town Clerk's Office
DATE:
41
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CHRISTIE
250 MIDWAY ROAD
SOUTHOLD