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ELIZABETH A.NEVILLE ,1 J 1 ; Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
evt, � Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS r
MARRIAGE OFFICER w �t� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =,_ (1:1 1°,1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���
OFFICE OF THE TOWN CLERK
SOUTHOLDIIT FEI SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2641 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 REINERTSEN, JOHN
Mailing Address 1 1850 ALBO DRIVE
City St Zip LAUREL NY 11948
Property Address 1 1850 ALBO DRIVE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 8 lot 12.000
Cross Street BRAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 8/13/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
1 ••I°1 OFF®l � Q(..oc(/
ELIZABETH A.NEVILLE ,�/ Al
4, Town Hall, 53095 Main Road
TOWN CLERK ` P.O.Box 1179
0,. - Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; Fax(631) 765-6145
MARRIAGE OFFICER e�i ',_.,—,f,..-,-;ey - es
RECORDS MANAGEMENT OFFICER _ y Y
®1 IS®veli 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: August 10, 2001
Transmitted herewith is a copy of application No. 2729 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for John Reinertsen
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.
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OFFICE OF THE TOWN CLERK ,�� , 02 7 02Y
TOWN OF SOUTHOLD
� �FF���CD Application No.
ELIZABETH A.NEVILLE,TOWN CLERK .' G�'
P.O.BOX 1179 � iO Con on
SOUHOLD,HOLD,NEW YORK 11971
Telephone O,y ,�Q•Vt't $10.00 - Residential t/
(631) 765-1800 "1' 46Y,,le' $25.00 -Non--Residential
4". sioar TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
' APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
DATE 31/7/0
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952 '
SEPTIC CESSPOOL
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: �Q A a RE;AIE 7 -w
OWNER MAILING ADDRESS: /850 A160 DA
/I,'f- If q r
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT "PERSON:
TAX MAP NO. : Section 12_6, , Block ® Lot /
CROSS STREET: 64;117-
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signature of/Applicant
RECEIVED BY:
NUG 1 i)o1Clerk's Office
DATE: Clerk
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Join Reinertsen
18:;0 Albo Drive
- 0-..4.4--. - - - - Laurel _ - -
_, r Town Of Southold
• P.O Box 1179
Southold, NY 11971
r
* * * RECEIPT * * *
Date: 08/10/01 Receipt#: 5813
Transaction(s): Subtotal
1 Septic Permit-Construct- Resid. $10.00
Check#: 5813 Total Paid: $10.00
Name: Peconic, Cesspool
P O Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID:38410