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JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
err $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER y� O� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER vl %role Telephone (516) 765-1800
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. 1510 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 AN OVERFLOW 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 MULLEN, PHILIP
Mailing Address 1 3340 OAKLAWN AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 3340 OAKLAWN AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 5 lot 54.001
Cross Street PINE NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 7/24/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY �i _ ` Town Hall, 53095 Main Road
TOWN CLERK % y = P.O. Box 1179
�t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS : r l�,�0 Fax (516) 765-1823
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MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER 7 [ �.a0"1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 0,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 22, 1996
Transmitted herewith is a copy of application No. 1575 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Phillip Mullen •
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 - 1.1°°/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Signatur /
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OFFICE 9F THE TOWN CLERK ,,,'"
Town of Southold so' stF /C-7
Judith T. Terry, Town Clerk � =; Application No.
Town Hall, 53095 Main Road Construction
P. O. Box 1179Z.lel Alteration
Southold, New York 11971
Telephone 0 $10.00 - Residential
Or
(516) 765-1801 " '1 4�, ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ l��o
DATE cA /
APPLICANT NAME: /"
(a4K-ecre
APPLICANT ADDRESS:
SEPTIC CESSPOOC4
DESCRIPTION 0 °ROPOSED CONSTRUC ON OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUC I N OR ALTERATION:
OWNER OF PROPERTY :
OWNER MAILING ADDRESS: �� 064it /fU.--e
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 7D Block S Lot Y/
CROSS STREET :
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY :
Town Clerk's Office
DATE:
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