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ELIZABETH A.NEVILLE 1 at ; Town Hall, 53095 Main Road
TOWN CLERK ; H - P.O. Box 1179
REGISTRAR OF VITAL STATISTICSera ,t Southold, New York 11971
MARRIAGE OFFICER ` .fi 'p. �1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ® ®°�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ����
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OFFICE OF THE TOWN CLERK
SOUTHOLD iiVAVIREMWEIRTRIXEMSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2672 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 SCH I LL, MARK
Mailing Address 1 1050 WATERVIEW DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 507 EIGHTH STREET
City St Zip GREENPORT NY 11944
Tax Map No. section 48.00 block 1 lot 22.000
Cross Street MAIN STREET
Building Permit Number Cross Reference:
Issue Date: 10/18/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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#01 �,�I Fath (° 7--
ELIZABETH A.NEVILLE ���� r # Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS V b
c#5Y'� � ��"" ��� Southold, New York 11971
MARRIAGE OFFICER w ` ."" .' ���� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Vo
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
Kira' ���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 3, 2001
Transmitted herewith is a copy of application No. 2763 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Mark Schill
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.
-24,(,.e/7s-1/*
Signature
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Dated
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OFFICE OF THE TOWN CLERK ,� c
TOWN OF SOUTHOLD ,,,' ��`F°�kcoG Application No.
ELIZABETH A.NEVILLE,TOWN CLERK t4
P.O.BOX 1179 • Construction L_—
SOUTHOLD,NEW YORK 11971 a T
Alteration
Telephonev4r."." $10.00 - Residential
(G3 t) 765-1800 =j�Y� �
l to' $25.00$25.00 -Non-Residential
/ #,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. -
Fee .$ • -
•
• • DATE
APPLICANT NAME:
APPLICANT ADDRESS: AO / 2G 972
SEPTIC CESSPOOL 1,
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: fl( rK 5o_k 11
OWNER MAILING ADDRESS: lb 50 Wo ter V .u) l rl'Ve
V 11971
OWNER PROPERTY ADDRESS: .50'7 g,,r3 /"j
r€e_n port
TELEPHONE NUMBER OF CONTACT PERSON: F— 'o 5 '
TAX MAP NO. : Section Block / Lot Z-2_
CROSS STREET: /7L4-r� .3 7 '
BUILDING PERMIT NUMBER CROSS REFERENCE:
S•Iff-c-e---1_gnature o is nt
RECEIVED BY: -
' Town C erk's Office
DATE: l49-7/3/0/
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MARK SCHILL
507 EIGHTH STREET
GREENPORT,NEW YORK