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ELIZABETH A.NEVILLE ����� '� "` Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS % gw
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MARRIAGE OFFICER ,, " ���, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _ ®/ r, f 40 ° 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. 2949 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 APOSTOLIDES, WILLIAM
Mailing Address 1 121 STRATFORD AVENUE
City St Zip GARDEN CITY NY 11530
Property Address 1 345 CAPTAIN KIDD DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 5 lot 5.000
Cross Street INLET DRI
Building Permit Number Cross Reference:
Issue Date: 12/26/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
(Q 9 Li
OFF04o=:
ELIZABETH A.NEVILLE ;� 4 ; Town Hall, 53095 Main Road
TOWN CLERK ‘93 - P.O. Box 1179
SoutholdNew York 11971
REGISTRAR OF VITAL STATISTICS B nor I ou '
MARRIAGE OFFICER Fax�����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER -0 '0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER i�'� southoldtown.northfork.net
771
OFFICE OF THE TOWN CLERK ,111 l 5
TOWN OF SOUTHOLD ;;
• 2 6 2002 —1`I
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TO: Southold Town Building Department ---`- s
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 26, 2002
Transmitted herewith is a copy of application No. 3070 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for Apostolides
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.
77,‘„,41,
Signature
/1 /2_
Dated ', x:;,.,
1 ,
OFFICE OF TSE TOWN CLERK_ , '111 FOOL
TOWNOFSOtTIIIOLD ,�� n'4. : Application No.
ELIZABETH A.NEVILLE,TOWN CLERK J►
P.o.BOX 1179 .` ; Construction '
SOUTHOLD,NEW YORK 11971 =v rn
Alteration
Telephone ;0 �Q�'�'� $10.00 - Residential
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(631) 765-1800 of 4�, 0°. $25.00 - Non-Residential
TOWN OF SOUTHOLD ,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION Or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. -
Fee .$
DATE //A���?s
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT 'ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952 •
SEPTIC CESSPOOL V
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: 64•
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OWNER MAILING ADDRESS: Z ,L
5Z7---Pet-/) _4-v 0—
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I //53 ' fOWNER PROPERTY ADDRESS: A 44 /2
TELEPHONE NUMBER OF CONTACT PERSON: S eY
TAX MAP NO. : Section t Block 5 Lot 5.16
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERE-ENCE:
•
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71iignature of Ap icant
RECEIVED BY:.
Town Clerk's Office
DATE: 4 •
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