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JUDITH T.TERRY � = y�e Town Hall, 53095 Main Road
TOWN CLERK y P.O. Box 1179
�. ; Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `6/ 11 Fax(516) 765-1$23
MARRIAGE OFFICER y 1
RECORDS MANAGEMENT OFFICER =�.( `�►��111 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,'0'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1645 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 KATZ, D.
Mailing Address 1 4975 BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 4975 BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 1 lot 2.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 4/22/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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cn Town Hall, 53095 Main Road
i1 `�'Q �- i P.O. Box 1179
"'htie � `��_= 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
IfiD: April 9, 1997 V(07
Transmitted herewith is a copy of application No. 1715 for an G �i• )-.r
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for D. Katz
•
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 Si• ' ture
--
APR2 1997
ate
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;,�. ;,` 6 d Town Clerk
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OFFICE OF THE TOWN CLERK '� FFO�
Town of Southold ,� 1t�j� Ke0 oc.." _ Application No./ 7/5--
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ' Construction
P. O. Box 1179 : o Alteration e..---->
Southold, New York 11971 W; -/
Tele hone %-....101r,. 4or��.` $10.00 -Residential
p
(516) 765-1801 = �l �, $25.00 -Non-Residential
•TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /99DATE 04°
APPLICANT NAME: //441/1 Al-ei',-°C/e -2.1t--L
APPLICANT ADDRESS: O - - r "4'
SEPTIC CESSPOOL"(
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION/
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCT ON OR ALTERATION:
OWNER OF PROPERTY : /: ' AO , /17--r--
OWNER
92 -OWNER MAILING ADDRESS: Y9?f igi !i/f'w Dc4P
s��fi./c9
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7is
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TAX MAP NO. : Section_ 117d Block / Lot 2
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
ii31
5' naturre/ of Applicant
RECEIVED BY :
Town Clerk's Office
DATE:
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