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JUDITH T.TERRY t�_ ?�`� Town Hall, 53095 Main Road
TOWN CLERK ; y 2 P.O. Box 1179
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it Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
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MARRIAGE OFFICER
``1i Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER �l `�►��106� Fax
(516) 765-1800
FREEDOM OF INFORMATION OFFICER , •1'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1547 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MICHAEL VERITY
Address 1 : P. O. BOX 476
City St Zip GREENPORT NY 11944
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-96-0030
Name Of Owner WALKER, GENE AND HEATHER
Mailing Address 1 GILLETTE DRIVE
City St Zip EAST MARION NY 11939
Property Address 1 GILLETE DRIVE
City St Zip EAST MARION NY 11939
Tax Map No. section 38.00 block 2 lot 26.000
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 9/30/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY is i ‘3-
y*t N Town Hall, 53095 Main Road
TOWN CLERK •;
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OFFICE OF THE TOWN CLERK ',1„ fedri, •
Town of Southold ,t0's 4- 40,--
Judith T. Terry, Town Clerk t` - ''''‘ ft9F•;\ Application No
Town Hall, 53095 Main Road j. i 4 ;741 Construction 1.....-- - 2:
P. 0. Box 1129 .: ' r lifi I
Alteration
Southold, New York 11971 i - .
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Telephone $10.00 - Residential i•-•-
(516) 765-1801 -- 44:# l'•V'''
---.... / I* , . $25.00 -Non-Residential
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TOWN OF SOUTHOLD .
• SOUTIIOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for ,
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
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Permit No. • -
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• Fee .$ /
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".. DATE
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•4; APPLICANT NAME: 3. /14-e--4* '9,
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APPLICANT ADDRESS: /t .. ..e&c•f, 97
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SEPTIC CESSPOOL
;• DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
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LOCATION OF PRVOSED CONSItill -T 1514 OR ALT RATION:
OWNER OF PROPERTY:
;". OWNER MAILING ADDRESS:
• od,--rsa' 71(4'4-c-^ - ,
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OWNER PROPERTY ADDRESS: • ' --4-•-e
___e6. e 214-eet-c...1;--s
TELEPHONE NUMBER OF CONTACT PERSON: •
TAX MAP NO. : Section 3 22 Block 2— Lot
CROSS STREET:
STREET: --7/Z.-/-1--" Z• /2e'r•••%2
BUILDING PERMIT NUMBER CROSS REFERENCE: _.....
am&
ignature of Applicant
RECEIVED BY :
Town Clerk's Office . •
DATE: •
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5l1FF0Lk CO. 141,,ALT14 ?F-Pfi:^F' O W4L,
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WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS MUST
. -; �. _—"� ' ' r-I Y CONFORM WI" NEW STANDARDS DATED NOVEMBER 13, 299:
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SERVICES
c ► 5 ' �' "'~.+• AT PERMIT FOR APPROVAL OF CONF!'RUC'T/ONii FOR A
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UNCLE.Pi ARMY RLSIUENCB ONLY
f r 1�` yam, •- EAST MAFt:.�O t. DA' s 0 1996 HS 4000-: •. A 0
2 FOR MAXIMUM OF BEDROOMS
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Z to- ��•. r,, r w'�� EXPIRES THREE YEARS FROM DATE OP APPROVAL
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