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ELIZABETH A.NEVILLE ��`1' �y �� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O Fax (516) 765-1823
MARRIAGE OFFICER � y 0N. Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER �Q 4. •.0
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. 1869 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
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 WICKHAM, GEKEE
Mailing Address 1 PRIVATE ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 345 CLARK ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 51 .00 block 3 lot 22.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 5/22/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFOtot
ELIZABETH A.NEVILLE Gym�` Town Hall, 53095 Main Road
TOWN CLERK
ti - , P.O. Box 1179
% Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v' PrI 1
Fax (516) 765-1823
MARRIAGE OFFICER : ## 1
RECORDS MANAGEMENT OFFICER : �l 0 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
Air
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 22, 1998
Transmitted herewith is a copy of application No. 1943 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Gekee Wickham
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 re mmendation:
APPROVE -
DISAPPROVE -
COMMENTS : Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
S'•nature
Date
0r
OFFICE OF THE TOWN CLERK 0' AFF ULK / 4/3TOWNOFSOUfHOLD /1.1
Q� SGApplication No. Y
ELIZABETH A.NEVIU.F,TOWN CLERK t
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 ; 72Alteration
Telephone ,y $10.00 - Residential
(516) 765-1801 �l " to $25.00 -Non-Residential
--
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /Q '3,9/DATE ,..2p2
APPLICANT NAME: /j?1i/4.50-40Z17-eWdea-,-
APPLICANT ADDRESS: 2,7 'O /14.00/4Cv rr D,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 CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C4"/(,fes - 'C/
OWNER MAILING ADDRESS: J V. #E , '42
_50c.,i'Ao(D r iv/
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 65 '^SPC
TAX MAP NO. : Section 57 Block � Lot 2 2.
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
(50.(./A; fi>47-7---;
Signature of Applicant
RECEIVED BY: (y� 9 ' �
Town Clerk s Office
DATE: ��
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