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JUDITH T.TERRY k�� y1 Town Hall, 53095 Main Road
TOWN CLERK 1 c
vs Z • P.O. Box 1179
Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS ‘14'°y ����, Fax(516) 765-1823
MARRIAGE OFFICER 4f O ��
RECORDS MANAGEMENT OFFICER �I * ,*Vold 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. 1764 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 WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner REYER, ROBERT
Mailing Address 1 1735 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 1735 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 1 lot 5.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 10/30/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY � _ 'y1`� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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nt t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516) 765-1823
MARRIAGE OFFICER �-°;# � /1�� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 1 80
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: October 30, 1997
Transmitted herewith is a copy of application No. 1838 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Robert Reyer •
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.
Si• ature
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Date
114,
OFFICErOF THE TOWN •CLERK °'",,,,,,
Town of Southold
Judith T. Terry, Town Clerk
_ Application No. O
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Town Hail, 53095 Main Road Construction
P. O. Box 1179 • Alteration
Southold, New York 11971 ------- —
Telephone
$10.00 -Residential v
(516) 765-1801 _ 1fit $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 / Joy (W7
APPLICANT .NAME: /7///7141-;
APPLICANT ADDRESS:
SEPTIC CESSPOOL--.(
DESCRIPTION OF PR POSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION 0 AL ERATION:
OWNER OF PROPERTY: '��L `
OWNER MAILING ADDRESS: /7f,� 4L � ' j
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: pis--„eyi
TAX MAP NO. : Section_ / 7 I Block 1 Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
/•
/ Signature of A/17/0,_1_,
cant
RECEIVED BY:
Town Clerk's Office
DATE:
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