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ELIZABETH
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ELIZABETH A.NEVILLE ��II�4 �'��; Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Pr? ,1 Southold, New York 11971
MARRIAGE OFFICER 4,iL g Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - . .9"
OFFICE OF THE TOWN CLERK
SOUTHOLD '1 $I E RP;`-d IfOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2704 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 SULLIVAN, RICHARD
Mailing Address 1 PO BOX 75
City St Zip NEW SUFFOLK NY 11956
Property Address 1 440 THIRD STREET
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 9 lot 20.000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference: 0
Issue Date: 12/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL) •
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ELIZABETH A.NEVILLE es.• . \; Town Hall, 53095 Main Road
•TOWN CLERK % p P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS �$ Southold, New York 11971
MARRIAGE OFFICER ® 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ® ®�'iix� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = °` ,��� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office 8LpU0G ° ��S14dt�O
10V01� __
DATED: November 28, 2001
Transmitted herewith is a copy of application No. 2800 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Cesspool for Dick Sullivan
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: r
Signature
//LA/
Dated
1
to
OFFICE OF THE TOWN CLERK C rrsZ
TOWN OFSOUTHOLD fi4P.
' C9 ��G=� Application No.
ELIZABETH A.NEVILLE,TOWN CLERK /P.O.BOX 1179 . ; Construction !/
SOUTHOLD,NEW YORK 11971 rn
Alteration
Telephone ,j' ft/ $10.00 - Residential 1/
(631) 765-1800 0/, ,e'� $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
APPLICATION
for NOV 282001
CONSTRUCTION or ALTERATION PERMIT
Southold Town Clerk
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$ •
DATE fifr- 6/0/
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MAATTITUCK, NEW YORK 11952
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: D✓e--/C
OWNER MAILING ADDRESS: �j /?(,, ,
/ ✓ e2 75
New i df0 F/ ®//c 895c,
OWNER PROPERTY ADDRESS: 9104 MiLd 57—
TELEPHONE
7TELEPf-ZONE NUMBER OF CONTACT PERSON: Off- ,96 so
TAX MAP NO. : Section HI Block % Lot g e)
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CROSS STREET: e4, 1 -
BUILDING PERMIT NUMBER CROSS REFERENCE:
A;/ .1/(/„,e/
•
r+� Signature of plicant
RECEIVED BY:
Town Clerk's Office
DATE:
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Richard Sullivan
440 Third Street
New Suffolk
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