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JUDITH T.TERRY it� y1 1 Town Hall, 53095 Main Road
TOWN CLERK ; y i P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS y �4��', Fax(516) 765-1823
MARRIAGE OFFICER *0 •Vw Fax
(516) -1823 765-1800
RECORDS MANAGEMENT OFFICER 1 * �►
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. 1570 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 ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner IRVING, JOHN
Mailing Address 1 45 MARQUETTE DRIVE
City St Zip SMITHTOWN NY 11787
Property Address 1 1620 BRAODWATER ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 9 lot 8.000
Cross Street HAYWATER ROAD
Building Permit Number Cross Reference:
Issue Date: 11/19/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/5706
O� G"
JUDITH T.TERRY ��_ y1 Town Hall, 53095 Main Road
TOWN CLERK y ? P.O. Box 1179
i
REGISTRAR.OF VITAL STATISTICS %%%%46
Southold, New York 11971
MARRIAGE OFFICER ��y� ��111' Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER of 4od1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: Novmeber 19, 1996
Transmitted herewith is a copy of application No. 1643 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for John Irving
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 follow' g recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signature
RECEIVED / /
fi-Z
Date
N OV 1 91996
Southold Town Clerk
OFF E OF THE TOWN CLERK
,,'' ,, '--. // //
Town of Southold .0"4001.1(0, = Application No./(O
3
Judith T. Terry, Town Clerk .4;:s
Town Hall, 53095 Main Road A 2 ; Construction
P. O. Box 1179 �r+ ; Alteration !/
Southold, New York 11971 �;
Telephone - Vk �.,i� $10.00 - Residential
p
(516) 765-1801 �Ol /,a $25.00 -Non-Residential
,.. i,'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $-- ------- DATE /C�! 7P -
APPLICANT
NAME:
APPLICANT ADDRESS: 277Q A' , ,
SEPTIC CESSPO(?6,1
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:
OWNER MAILING ADDRESS:
/ \
07
OWNER PROPERTY ADDRESS: / ;o
TELEPHONE NUMBER OF CONTACT PERSON: La-,.5 -159C-re)
TAX MAP NO. : Section Block Lot er
CROSS STREET: /, •
BUILDING PERMIT NUMBER CROSS REFERENCE:
F&T 51/1/1*-r'1'
- /Signature of Applicant
RECEIVED BY: 1111 I
'own Clerk's Office
DATE: / /J( � 7fc
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