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ELIZABETH A.NEVILLE • Town Hall, 53095 Main Road
TOWN CLERK y - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS PIT i% Fax
Southold, New York 11971
MARRIAGE OFFICER ,L Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `may_"'/�1 ��." Telephone(631) 765-1800
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FREEDOM OF INFORMATION OFFICE ���� 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. 3018 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 PAMELA, ALLEN
Mailing Address 1 1355 KENNYS ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 1355 KENNY'S ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 7 lot 18.000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 4/17/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
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. ,�o�0S11EF0[,�co,\ 3 g(
ELIZABETH A.NEVILLE �_ 4\ Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179 ,
y 2 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Pri
MARRIAGE OFFICER Fax(631) 765-6145
:� 10 � �1
RECORDS MANAGEMENT OFFICER �_"'/Ql • iiii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ W �i' southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD — — -
-
• r i '
i .,
TO: Southold Town Building Department ; ' 1.2 6 3103
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 26, 2003
Transmitted herewith is a copy of application No. 3141 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Pamela Allen
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
G,3
Dated
n " i
OFFICE OF THE TOWN CLERK 11° 40 airCApplication
TOW ��'
N OF SOUTHOLD fi Av I
ELIZABETH A.NEVILLE,TOWN CLERK
�G pplication
No.
P.O.BOX 1179 � . • . ; Construction l/
SOUTHOLD,NEW YORK 11971 ;
A Alteration
Telephone 0 �Q�I.'�, $10.00 - Residential%
(631-) 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 03/06/03
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952 •
SEPTIC CESSPOOL 1✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
tereae1 -)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST UCTION OR ALTERATION:
. OWNER OF PROPERTY: ,C�,y0:440._J,
OWNER MAILING ADDRESS: /.355 / S /'
\-5•Thatad
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON 9er�/9,5F
TAX MAP NO. : Section g9 Block 7 Lot /4
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
• s
Signature of Apoicant
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killar
RECEIVED BY•/-�
own Clerk's Office
DATE:
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Pamela Allen
1355 Kennys Road
I , Southold