HomeMy WebLinkAboutClay, Barbara ti
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JUDITH T.TERRY �,,o y< Town Hall, 53095 Main Road
TOWN CLERK ti P.O. Box 1179
t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 4;*
Fax(516) 765-1823
MARRIAGE OFFICER ;IJ O��
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RECORDS MANAGEMENT OFFICER �l'J a�d� 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. 1763 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner CLAY, BARBARA
Mailing Address 1 52645 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 52645 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 63.00 block 5 lot 14.000
Cross Street HORTON LANE
Building Permit Number Cross Reference:
Issue Date: 10/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY tl_, yet Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
v. /,1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O • . 516) 765-1823
MARRIAGE OFFICER O�y 11
RECORDS MANAGEMENT OFFICER N. -101 * �a0�1 11 :h., e - •- .e 800
FREEDOM OF INFORMATION OFFICER ,iitoof l., t I(�
OCT 01997 i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD �G•DEFT
TO: Southold Town Building Department • •
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 30, 1997
Transmitted herewith is a copy of application No. 1837 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Barbara Clay
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
gn'ature
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Date
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OFFICE OF THE TOWN •CLERK v,„,,,,,,, ,,- �i
Town of Southold 0.'"r0106Application No. 11
Judith T. Terry, Town Clerk �' �J►�;
Town Hall, 53095 Main Road ;L ; Construction
P. O. Box 1179 Alteration j/
Southold, New York 11971
Telephone ‘1...,%41011._
` A,�'
$10.00 -Residential t/
a 1
(516) 765-1801 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 $ /
DATEjW4.30 I
W7
APPLICANT NAME: a614172eftre
APPLICANT ADDRESS:
SEPTIC CESSPOOL:
DESCRIPTION OF PR OSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTEATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: ' 442
OWNER PROPERTY ADDRESS: !`L 1_-,0, •
•
TELEPHONE NUMBER OF CONTACT PERSON: 7‘1:: �� )
TAX MAP NO. : Section �,__5 Block •5 Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
9 -
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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