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ELIZABETH A. NEVILLE �' 4' Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,,t� Southold, New York 11971
MARRIAGE OFFICER : U � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _ �®,'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,��
OFFICE OF THE TOWN CLERK
SOUTHOLD ETtrElpSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2691 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 TANDY, JOHN
Mailing Address 1 PO BOX 1727
City St Zip RIVERHEAD NY 11901
Property Address 1 2000 PIKE STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 3 lot 21 .000
Cross Street WICKHAM AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/19/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� °� ` Town Hall, 53095 Main Road
TOWN CLERK ; � ,-°' P.O. Box 1179
`t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � � `�'��� t=;��,;� �' �
MARRIAGE OFFICER s _ ���1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � �
®� ,,.ssZZ,, ��®,i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ `z9 �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 2, 2001
Transmitted herewith is a copy of application No. 2784 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for John Tandy
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.
Signature
Dated
.7
OFFICE OF THE TOWN CLERK .111 !UL L ,
TONOFSOUTHOLD �%6� c'J CQG Application No / u el
W
ELIZABETH A.NEVILLE,TOWN CLERK 0
.P.O.BOX 1179 ? ;� ; Construction L�
SOUTHOLD,NEW YORK 11971 '
Alteration
Telephone $10.00 - Residential 1. -
(63'1) 765-1800 = 1 * „ • $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
-: .APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE i®/z74 /
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
1 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:
OWNER MAILING ADDRESS: /f), ,�� / /7p1'7
OWNER PROPERTY ADDRESS: 0' 7"7 j2C
TELEPHONE NUMBER OF CONTACT PERSON: nn
TAX MAP NO. : Section /%'d Block 3 Lot rJ'�
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Ap•4cant
RECEIVED BY:
Town Clerk's Office
DATE:
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Jahn Tandy
----- -------__..—. 21100 Pike Street
Mattituck
7 ,';'
,:..ii
Town Of Southold
P.O Box 1179
4 - Southold, NY 11971
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* * * RECEIPT * * *
Date: 11/02/01 Receipt#: 6001
Transaction(s): Subtotal
1 Septic Permit- Construct- Resid. $10.00
' Check#: 6001 Total Paid: $10.00
Name: Peconic, Cesspool
P O Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID:41719