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ELIZABETH A.NEVILLE pits� ", ".��44; Town Hall, 53095 Main Road
TOWN CLERK = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , i Southold, New York 11971
MARRIAGE OFFICER ���1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = ®� � �� Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER _ ��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2730 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 MARVIN, ARLENE
Mailing Address 1 BOX 28
City St Zip NEW SUFFOLK NY 11956
Property Address 1 1635 ACKERLY POND LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 69.00 block 5 lot 8.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 2/20/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
/IF OFFOit 9
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••ELIZABETH A.NEVILLE 40 Gyd • Town Hall, 53095 Main Road
TOWN CLERK y - P.O. Box 1179
Southold,
REGISTRAR OF VITAL STATISTICS V �
���,�
New York 11971
MARRIAGE OFFICER `� �i �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ,-749d le" Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ,s' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
4�n1 l� l!a7 1; ...... _1 1
"
TO: Southold Town Building Department ', .sl ` \'
;, JAN 1 5 112
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 14, 2002 --
Transmitted herewith is a copy of application No. 2824 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Arlene Marvin
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 to ation 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.
7.74,,,e2/9 )
Signature
D/ /1.5-70
Dated
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OFFICE OF THE TOWN CLERK ���
TOWN OF SOUTHOLD ���c9������CQy-� Application No �a
ELIZABETH A.NEVILLE,TOWN CLERK 1 J►
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 rn
Alteration
Telephone ,y �' 7.94 $10.0' -'sl.ential eO
G31) 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 /We
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
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: Amp/
OWNER MAILING ADDRESS: /5202t, ? "
.44-74.4 .5 L, L✓/ - s4'
OWNER PROPERTY ADDRESS: /63 7 4-G,./re/ P'e7sz',,
TELEPHONE NUMBER OF CONTACT PERSON: 7�'°',GS'Y
TAX MAP NO. : Section 6 gr Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of A ica� lt
RECEIVED BY: ie
Town CIe k's Office
DATE: /
Town Of Southold
P.O Box 1179
1 Southold, NY 11971
u
* * * RECEIPT * * *
Date: 01/14/02 Receipt#: 6145
Transaction(s): Subtotal
1 Septic Permit- Construct- Resid. $10.00
Check#: 6145 Total Paid: $10.00
Name: Peconic, Cesspool
P 0 Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID 47029
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Mrs. Arlene Marvin '
1635 Ackerly Pond Road
Southold