HomeMy WebLinkAboutBrown, James ilif Of F04 %
JUDITH T.TERRY %t y1 Town Hall, 53095 Main Road
TOWN CLERK ; N = 1 P.O. Box 1179
% $111
$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER yifJ "el
11Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER : -1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER '—.•.,, ,•"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1503 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 BROWN, JAMES
Mailing Address 1 P. O. BOX 630
City St Zip CUTCHOGUE NY 11935
Property Address 1 170 OAK STREET
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 136.00 block 1 lot 52.000
Cross Street HARBOR LANE
Building Permit Number Cross Reference:
Issue Date: 6/28/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ,��i• yt Town Hall, 53095 Main Road
TOWN CLERK % y = P.O. Box 1179
T ,t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER yif' 0. �1�' Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER % 49l * +,01 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ••„„ ,0"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD , '_- ; 2 7 1996
4
TO: Southold Town BuildingDepartment T_� l
p BLDG.DEPT.
TOWN OF SOUTHOLD I
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 27, 1996
IllP.Transmitted herewith is a copy of application No. A1568 for - pool/
T s ruction Permit submitted by: G // :s/ -
Morris Cesspool for James Brown
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recomm ations:
APPROVE
DISAPPROVE
Comments: CLe47 /47 --fd
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Signatur 7 ' /'
Dated 7
OFFICE OF THE 'GOWN CLERK ""
Town of Southold o' 4FRA# _ l cg
Judith T. Terry, Town Clerk Application No.
Town Hall, 53095 Main Road
` = Construction
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone ,+
$10.00 -Residential
.� '
(516) 765-1801 ,i�
T $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE (�. .2 7 /P1'
APPLICANT NAME: �, Z S
APPLICANT ADDRESS:
SEPTIC CESSP00L-1/
DESCRIPTION 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: O 09/' f r
8d,& pfd
OWNER PROPERTY ADDRESS: C /,L f c NQec��
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /f6 Block / Lot j� 2
CROSS STREET: 4., h
BUILDING PERMIT NUMBER CROSS REFERENCE:
99
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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