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ELIZABETH A.NEVILLE ����� ��d; Town Hall, 53095 Main Road
TOWN CLERK a i P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ,�� Southold, New York 11971
MARRIAGE OFFICER �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � ® �� ��i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER � �,I
OFFICE OF THE TOWN CLERK
SOUTHOLD INASTEMAgnEIRTIIMENDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2625 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 WEISSERT, WILLIAM
Mailing Address 1 3440 WELLS AVENUE
City St Zip PECONIC NY 11958
Property Address 1 3440 WELLS AVENUE
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 1 lot 13.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 8/08/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK ; =` P.O. Box 1179
REGISTRAR OF VITAL STATISTICS1,10 PPP 1 Southold, New York 11971
MARRIAGE OFFICER `. �i ` ®� ��� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_ ®/ �I Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ����
p -�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ; `, � � G �� +
ti.;'
TO: Southold Town Building Department +--- -- —
L !r), 2 �:-,•I' ;)L
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 19, 2001
Transmitted herewith is a copy of application No. 2711 for a Cesspool/Septic Tank Construction Permit
submitted by:
Peconic Cesspool for Weissert
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:
ignature
'! 3 O 1 I
Dated
OFFICE OF THE TOWN CLERK �' /,,"•OL/',•'•
' ��FFD�k`►OG�-; Application No. G114
TOWN OF SOUTHOLD •
ELIZABETH A.NEVILLE,TOWN CLERK �• Q Construction —
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971rn
Alteration
v' ,rte
Telephone �Q��•� $10.00 - Residential
631-.) 765-1800 =- .t I 'y
�.
�� $25.00 -Non-Residential
.,#,l#lol
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE .7//9/0/
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
{ MATTITUCK, NEW YORK 11952 '
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION •
, - ' / /- �� J,44-r1
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /,( , Afte--42
OWNER MAILING ADDRESS: �.41)
vi5-
OWNER PROPERTY ADDRESS:
•
TELEPHONE\ NUMBER OF CONTACT PERSON: a '6.51K
TAX MAP NO. : Section g:6 Block , / Lot /3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of pplicant
RECEIVED BY:
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