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ELIZABETH A.NEVILLE �O "'> �� ; Town Hall, 53095 Main Road
TOWN CLERK CD '' 0 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS \ hX +�� Southold, New York 11971
MARRIAGE OFFICER Lt Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ®� • �o Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER -- aZg
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OFFICE OF THE TOWN CLERK
SOUTHOLD rttkrisNUYsTligtrOdfiRPSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2705 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 DURAN, RITA
Mailing Address 1 2948 LEXINGTON AVENUE
City St Zip MOHEGAN LAKE NY 10547
Property Address 1 1145 SMITH DRIVE SOUTH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 76.00 block 2 lot 23.000
Cross Street TERRY STREET
Building Permit Number Cross Reference:
Issue Date: 12/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
I ,. C-71 ---) (4,35 /
ELIZABETH A.NEVILLE ��0� \ �o6't\`
Town Hall, 53095 Main Road
•
TOWN CLERK % ® ;'• - _ , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS • Southold, New York 11971
MARRIAGE OFFICER • - C) V # Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER /eel Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = ® �,I southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD REMNOVErill
.,„, al NOV 2 ?nor 1.I.JJ
TO: Southold Town Building Department
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BLDG.DEPT. ;4",
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FROM: Linda J. Cooper, Southold Town Clerk's Office ' TOWNAF SOUTHOLD
DATED: November 28, 2001
Transmitted herewith is a copy of application No. - 2801 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Rita Duran
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:
Signature
h./3o//
Dated
OFFICE OF THE TOWN CLERK '���FOL� 401
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Rita.Duran
1145 Smith Drive South
1 Southold
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