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ELIZABETH A. NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS ® e� �� Southold, New York 11971Fax (631) 765-6145
MARRIAGE OFFICER : eo
RECORDS MANAGEMENT OFFICER �;_ ®1 4
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FREEDOM OF INFORMATION OFFICER _ ,�°��� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2776 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 GINNY HARMS & ROBERT KUHNE
Mailing Address 1 PO BOX 636
City St Zip NEW SUFFOLK NY 11956
Property Address 1 50 GEORGE ROAD
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 4 lot 1 .000
Cross Street FRED ROAD
Building Permit Number Cross Reference:
Issue Date: 3/21/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �I'I ' 1 ‘ Town Hall, 53095 Main Road
TOWN CLERK O - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` ® 'Pt Southold, New York 11971
Fax(631) 765-6145
MARRIAGE OFFICER ,L
RECORDS MANAGEMENT OFFICER `may"'/Q ��iii�1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER via southoldtown.northfork.net
t I OFFICE OF THE TOWN CLERK
MAR ( 4 20 ' �..'..'
I ' TOWN OF SOUTHOLD
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T.0 = LI' Foothold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 14, 2002
Transmitted herewith is a copy of application No. 2874 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Ginny Harms &Robert Kuhne
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
,0/4/9 2--
Dated
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OMCBOFTHE TOWN CLERIC ,�i' x ' G
TOWN OF SOUTHOLD * ° Application�'Q Application No.oQ 7y
ELIZABETH A.NEVILLE,TOWN CLERK � 0 G�
P.O.BOX 1179 ; C• . _ i o n
SOUTHOLD,NEW YORK 11971
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Telephone ���� $10.00 - ' esidential
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(63.1) 765-1800 = '1,;' ' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE q/010).---
.
APPLICANT NAME: PECONIC CESSPOOL '
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
G iAe--t/E
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONS . UCTION OR ALTERATION:
. OWNER OF PROPERTY:
OWNER MAILING ADDRESS:, 1_
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OWNER PROPERTY ADDRESS:
Ate,..x) .t J/1
TELEPHONE NUMBER OF CONTACT PERSON: c'9d - 9t S3
TAX MAP NO. : Section 1/7 Block Lot I
CRS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignatur!of Applicant
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RECEIVED BY: e
Town CI rk's Office
DATE: 3— /'`'O Z •
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Robert Kubne&Ginny Harms
50 George Road
New Suffolk -
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SEWER&DRAIN SERVICE
P.O. BOX 972 BRAY AVENUE MATTITUCK, NEW YORK 11952
(631)298-9658
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• Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 03/14/02 Receipt#: 6262
Transaction(s): Subtotal
1 Septic Permit- Construct- Resid. $10.00
Check#: 6262 Total Paid: $10.00
Name: Peconic, Cesspool
P 0 Box 972
Mattituck, NY 11952
Clerk ID: LINDAC Internal ID:51171
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Robert Kuhne&Girmy Farms
50 George Road
New Suffolk