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Home My WebLink AboutDart, Alice .. ` :. �tii • � g Town Hall, 53095 Main Road tri P.O. Box 1179 14,1,r0 Southold, New York 11971 416 JUDITH T.TERRY �.% .K/1 — TELEPHONE TOWN CLERK \��+• (516) 765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1587 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 ADJACENT WELLS BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner DART, ALICE Mailing Address 1 2425 MAIN BAYVIEW ROAD City St Zip SOUTHODL NY 11971 Property Address 1 2425 MAIN BAYVIEW ROAD City St Zip SOUTHOLD NY 11971 Tax Map No. section 78.00 block 1 lot 10.019 Cross Street Building Permit Number Cross Reference: Issue Date: 12/20/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) ••,/1�Stf FOUr = /3 JUDITH T.TERRY � _ ?�`� Town Hall, 53095 Main Road TOWN CLERK 2 1 P.O. Box 1179 % r � Southold, New York 11971 REGISTRAR OF VITAL STATISTICS `� G MARRIAGE OFFICER �1� Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER : 49l `�►aOl°1� Telephone(516) 765-1800 FREEDOM OF INFORMATION OFFICER 1� � OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda Cooper, Southold Town Clerk's Office DATED: December 18, 1996 Transmitted herewith is a copy of application No. for an ALTERATION PERMIT for a cesspool or septic system submitted by Morris Cesspool for Alice Dart • 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. RECEIVED DEC 2 0 1996 Signatur Southold Town Clerk /a//'9' 9G Date OFFICE Oy THE TOWN CLERK ,'' --Town of Southold " F gUrze Application No. /(o s Judith T. Terry, Town Clerk � tc` Town Hall, 53095 Main Road ; ; Construction P. 0. Box 1179 M ; Alteration Southold, New York 11971 Telephone `�OQ � �,i $10.00 -Residential (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 $ DATE 4, APPLICANT NAME: ifi/Z APPLICANT ADDRESS: a 2(G 5A SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONST RUCT IO OR ALTERATION: OWNER OF PROPERTY: OWNER MAILING ADDRESS: / V2r ; 15, ,- OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT� PERSON: r TAX MAP NO. : Section r Block / Lot / . /P CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: _O__d-(7friSa /r4-77/ 12' Signature of Applicant RECEIVED BY : /, Tow Clerk's O DATE: /l Ph /P !1 P 6-c10 r < r V d _40.0 5