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JUDITH T.TERRY • =�0 Gy�c Town Hall, 53095 Main Road
TOWN CLERK ;
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JUDITH T.TERRY ��= ,•A • Town Hall, 53095 Main Road
• TOWN CLERK ; N i P.O. Box 1179
7 $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ` O
MARRIAGE OFFICER " 'y,* �� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER i RI 4, *lop' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLDA�
TO: Southold Town Building Department 0
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: September 27, 1996
Transmitted herewith is a copy of application No. 1619 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Susan Kwit (work by Ray Nine)
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.
WO WW1 PISS
9661 L 13 0 Signature
03/11333b1 /e07 Date
' OFFICE THE TOWN CLERK
l'own of Southold
Application N•.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction _
P. O. Box 1179o n+ ; Alteration
Southold, New York 11971 ;4$1 � --------
Telephone ���,i� $10.00 - Residential#2,2 i'A ` r-/6
(516) 765-1801 r $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE — _VI / ?4.
— --
APPLICANT NAME: 5 C,I rS f-PI F1 . <t,Li i----_-_ T---------------------------__-
APPLICANT ADDRESS: /C CO C%1 -b F/A-R1C R R,Ot p_—__--
S U F F cL-IL ► '� `�5 6—--- ---
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
- -r-ter, 0P- 8'x$ `Cess poo L o v-6 ce-ss rootc
lin A R P-t<vAON _N F L_..wt o v
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSE[) CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : t,.95IV I .14-w I T--__— --
OWNER MAILING ADDRESS: 155 C 1 7d S 1 n-13:€ _____�_�____ _.
OWNER PROPERTY ADDRESS: C01O1-0 if, 80FL ‘2010-10
TELEPHONE NUMBER OF CONTACT PERSON : ?f1(1 /wiv -: o a,q e "" 66,2E3
TAX MAP NO. : Section / ./T7 Block 5 Lot /o2,
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
X'\//
ignature of Appli ant
RECEIVED BY :
Town Clerk's Office
DATE:
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