HomeMy WebLinkAboutDiack, Mildred 4
ULke‘11
•
Town Hall, 53095 Main Road
Irl •W� P.O. Box 1179
X1eit��. tZt-
144% ��riv Southold, New York 11971
JUDITH T.TERRY � 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. 1710 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 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 DIACK, MILDRED ANN
Mailing Address 1 1840 LEETON DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 1840 LEETON DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 58.00 block 2 lot 11 .000
Cross Street KENNY'S ROAD
Building Permit Number Cross Reference:
Issue Date: 8/04/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
?c ULI(\
BX t
$l Town Hall, 53095 Main Road
/ 0.1
• P.O, Box 1179
41��� 0 Southold, New York 11971
JUDITH T.TERRY `•••• TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: August 4, 1997
Transmitted herewith is a copy of application No. 1780 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Diack
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.
-o
gnature 1111
g
Date
s
OFF'ICf' OF THE TOWN CLERK ,o'
Town of SoutholdTown Clerk
Clerk v
Application No. / 7e
Judith T. Terry, �` ����►
Town Hall, 53095 Main Road Construction
P. O. Box 1179 Alteration !/
Southold, New York 11971
$10.00 - Residential
Telephone
(516) 765-1801 _ 1 11 $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__
APPLICANT NAME:
APPLICANT ADDRESS: Z.7 <
fo
SEPTIC CESSPOOL"
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: MI 4 ,0rq-c��--
OWNER MAILING ADDRESS: /f 1w La�2%
'7/
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 2c3-- fpc)---a
TAX MAP NO. : Section 3Block Z Lot /1
CROSS STREET: ki2,1, 7
BUILDING PERMIT NUMBER CROSS REFERENCE:
//V//-6‘
Sig ature of Applicant
RECEIVED BY: . ��
Td�OT1eOffice— —
DATE:
AUS 41997-_
Southold Town Clerk
e
20/V