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ELIZABETH A.NEVILLE �� �° Gy ; Town Hall, 53095 Main Road
TOWN CLERK ` ® P.O. Box 1179
nay Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
4 �� Fax (631) 765-6145
MARRIAGE OFFICER . �1
RECORDS MANAGEMENT OFFICER =_�®1 jig $b��1i' Telephone (631) 765-1800
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. 2784 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 SHARKEY, WALTER
Mailing Address 1 PO BOX 1558
City St Zip MATTITUCK NY 11952
Property Address 1 1930 MARLENE LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 144.00 block 2 lot 3.200
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 4/04/02 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
0004 (9 73-
tir ELIZABETH A. NEVILLE �,,��o '` �* ; Town Hall, 53095 Main Road
TOWN CLERK % o - P.O. Box 1179
A • Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER : #4,
i `. �1
RECORDS MANAGEMENT OFFICER =___®1 �a®•1 Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
>t i1
2 a 2002 "l is
TO: Southold Town Building Department
P,-DG DEPT
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 20, 2002
Transmitted herewith is a copy of application No. 2885 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Walter Sharkey
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: 1,711
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
Dated
OFFICE OF THE TOWN CLERK ��0Lke
TOWN OF SOUTHOLD ��6i n%: Application No.
ELIZABETH A.NEVILLE,TOWN CLERK o�T
P.o.BOX i179 : Construction
SOUTHOLD,NEW YORK 11971 ern
I Alteration
Telephone �O•P1, $10.00 - Residential
(63t) 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 ._.3/G� Q .2/
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952
SEPTIC CESSPOOL
DESCRIPTIONIF PROPOSED CONSTRUCTION OR ALTERATION
�._ _
LOCATION MAP: Must be attached hereto before permit may be issued.
, LOCATION OF PROPOSED CONSTRUCTION OR ALT RATION:
OWNER OF PROPERTY: /4
OWNER MAILING ADDRESS: ep / /5s-es,
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OWNER PROPERTY ADDRESS: q30 J i ve7je_. Ave_.
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TELEPHONE NUMBER OF r// V
CONTACT PERSON:
TAX MAP NO. : Section / 41V Block 2- Lot I, 3
C S'S—STREET: /4Wi(.v ../f eke
BUILDING PERMIT NUMBER CROSS REFERENCE:
a4 ,41 A ///' •
Sire of licant
RECEIVED BY k
Town Clerk's Office
DATE: (-3/267":007.
/01-4/1-1/Ck
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Walter Sharkey
1930 Marlene Lane
Mattituck
ELIZABETH A. NEVILLE,TOWN CLERK
Town of Southold
Southold, New York 11971
r s Phone: 631-765-1800
RECEIPT #2885
Peconic, Cesspool
P 0 Box 972
Mattituck, NY 11952
Received $ 10.00
1 - Septic Permit - Construct - Resid. on 03/20/2002.
Thank you.
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