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JUDITH T.TERRY t°� y1 1Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
• 1 i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ;Oe1, Fax (516) 765-1823
MARRIAGE OFFICER Ly, S1,v Telephone(516) 765 1800
RECORDS MANAGEMENT OFFICER •� `1►
FREEDOM OF INFORMATION OFFICER ,.'.i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1559 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner BRACHFELD, EMANUEL
Mailing Address 1 2615 SIGSBEE ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 2615 SIGSBEE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 144.00 block 2 lot 26.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 10/29/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ��� y< Town Hall, 53095 Main Road
TOWN CLERK ; y = ; P.O. Box 1179
$ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y* O� '1�1 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ! * 'Desi' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ' 006
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 29, 1996
Transmitted herewith is a copy of application No. 1630 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Emanuel Brachfeld
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - V/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
7:e:e7
Signature
/07,=.<?.
Date
OFFICE OF THE TOWN CLERK civ,,,,,,,,,""'-
Town of Southold OFOL v
Judith T. Terry,
Town Clerk K�� Application No. —2
Town Hall, 53095 Main Road .4. : Construction
P. O. Box 1179 cf,, s= Alteration
Southold, New York 11971 ;i 4;
Telephone �Dif. �����` $10.00 - Residential / '
(516) 65-1801 '�l �, �! $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 t 2F 49c
APPLICANT NAME: f,&-/Lt--; C4--61-41/(-- --ereA2Jz—z.
APPLICANT ADDRESS: , 260 i I
SEPTIC CESSPOOL^
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
--a (A-e--'41-ar-,t)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY "717#/t LCA:L— 46e/ C'f7/%''IS
OWNER MAILING ADDRESS: 2 75.- L�i' x',6/_4 r O
/2 r
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /V / Block ,? Lot .‘. _`
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
/ )1' .(f%' / fYle)-14'
Signature of Applicant
RECEIVED BY: /) 44,_,_._/
o—n - k's Office
DATE: / ± f6
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