HomeMy WebLinkAboutRotert 0111 FOL 40.1"
\ELIZABETH A. ELE ;I OGy� � Town Hall, 53095 Main Road
TOWN CLERKc _ P.O. Box 1179
co) Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �I Fax (516) 765-1823
MARRIAGE OFFICER �� Ifi �1
RECORDS MANAGEMENT OFFICER �01 a� 1 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. 1903 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 ROTERT
Mailing Address 1 LAKE DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 LAKE DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 80.00 block 3 lot 17.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 7/21/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
G.
ELIZABETH A.NEVILLE •�`t` . Town Hall, 53095 Main Road
TOWN CLERK p r4P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 0 $ Fax (516) 765-1823
MARRIAGE OFFICER � y 0-•OS Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
ig
FREEDOM OF INFORMATION OFFICER Ol 0.0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 16, 1998
Transmitted herewith is a copy of application No. 1978 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Mr. Rotert
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 folio 'ng recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signat
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Date
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4.
OFFICE OF THE TOWN CLERK "
TOWN OF80UI'IIOLD ,°' ��
y Application No. 97°p
F J7ABETH A.NEVIL E,TOWN CLERK ;' ,r
P.O.BOX 1179 ` Const ruction
SOUTHOLD,NEW YORK 11971 '
Alteration
''' .R $10.00 -Residential
Telephone _ tla -
(516) 765-1801
�"" $25.00 -Non-Residential
-APOTOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ DAT
E � / M71x
APPLICANT NAME: .717e'€/2rJ
e4444a77)"
APPLICANT ADDRESS: 2 7,�'4 j�
SEPTIC CESSPOOL/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
072-eAr--r.J
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTE -" TION:
OWNER OF PROPERTY: Q 7E/Z/'---
OWNER MAILING ADDRESS: /2/e A "ee
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:/$ F?1�
TAX MAP NO. : Section 8000 Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
C/ D/Ofr.
470
ignature of Applicant
RECEIVED BY: ( •- R&L,
Town Glerk's Office
DATE: rl- 16- 9
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