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.i A \ELIZABETH A.NEVILLE ��ti� �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 11.79
REGISTRAR OF VITAL STATISTICS ��
Southold New York 11971
MARRIAGE OFFICER ` ®,$ ����� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �,_�®� ��®,i� 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. 2938 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 FRERICKS, HELEN
Mailing Address 1 4830 DEEP HOLE DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 4830 DEEP HOLE DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 1.000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number cross Reference:
Issue Date: 12/17/02 Elizabeth A. Neville
southold Town clerk
(TOWN SEAL)
.Ike,-- ,-i of/ OFFOL4' "\. 0?93 3/
ELIZABETH A.NEVILLE lf O V Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � i Southold, New York 11971
MARRIAGE OFFICER `` 4 l��1�, Fax(631) 765-6145
RECORDS MANA�GG MENT+OFFICER =_Biel �,�� o' Telephone (631) 765-1800
FREEDOM O I3�FTpRMAT OFFICER •„ ” southoldtown.northfork.net
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\\`.) ,r 3 ®2Q02' OFFICE OF THE TOWN CLERK
�� OG, TOWN OF SOUTHOLD
TO: iovIla'ry'` Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 30, 2002
Transmitted herewith is a copy of application No. 3057 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Helen Frerichs
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.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations: /
APPROVE
1/
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
27,‘,.‘4.fif,(2.::......
Signature
/V/3//2—
Dated
-
OFFICE OF TILE TOWN CLERK 1"' OLk '
TOW �,NOFSOUTNOLD r' s'�Q�'J Application No. 5`S
ELIZABETH A.NEVILLE,TOWN CLERK �" : e6ns on �—
P.O.BOX 1179 �
SOUTHOLD,NEW YORK 11971 rn 1
• . rn = ;:A'lte`r`- '.
Telephone •
4%, Q�"t�'� $10.00 = R-esidential li
(631) 765-1800 ' -�-�01' ����
�,�� $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION • -
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952 •
SEPTIC CESSPOOL
DyCR 'TION 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:
OWNER MAILING ADDRESS: .p3e, )44/6-- 4f? _
.77/7 ,cif /��f- /05'2_
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT ,PEON: 9P"5(
TAX MAP NO. : Section as- Block / 7 Lot /
CROSS STREET:`
BUILDING PERMIT NUMBER CROSS REFERErCE: �--
Signature of A•i•Iicant- ''
RECEIVED BY:
Town Clerk's Office
•
•
DATE:
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HELEN FRERICHS
4830 DEEP HOLE DRIVE
MATTITUCK