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*.$, P.O. Box 1179
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JUDITH T. TERRY ������ " �ll1l TELEPHONE.
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 480 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS, DAYSMAN
Address 1 : MORRIS CESSPOOL SERVICE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF NEW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED ON SKETCH. ADHERE TO 15'0" MAXIMUM DISTANCE.
Name Of Owner CANEJA, SUSAN AND OTHERS
Mailing Address 1 330 DOGWOOD LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 330 DOGWOOD LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 8 lot 3.000
Cross Street KENNY'S ROAD
Building Permit Number Cross Reference:
Issue Date: 4/04/89 Judith T. Terry
Southold Town Clerk
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%'Z"" "` et ' `�`� (TOWN SEAL)
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�•��� Town Hall, 53095 Main Road
�Q��•• P.O. Box 1179
t ��� Southold, New York 11971
JUDITH T. TERRY 4"1"-....~'01°' TELEPHONE
TOWN CLERK
_ (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD r �v(
March 29, 1989 MAR 2 9
1989 t
To: Victor Lessard, Southold Town Building Depart ent TOW�e< . '
t
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A490 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Susan Caneja and others
•
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 - X
DISAPPROVE -
COMMENTS: p!, ,c.,.►r gi o tQ.. o-,.t 3 bm, . cu, c)
141
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Signature
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Date
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OFFICE OF THE TOWN CLERK �o%�FFOL 1
Town of y0 y Application No. yid
Judith T. Terry, Town Clerk -G
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971P ,yam O�o�`J Alteration ✓
Telephone 01 ' � Residential i
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ 7e,
DATE ,i.t/ 0%2 T, l 77
APPLICANT NAME: C_) 4L11. ) (9eda,
APPLICANT ADDRESS: 330 /czAl..Q__,
2 /(F7/
SEPTIC CESSPOOL (/'
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
d c -c_ 'J ,-n.et,.J a4-6--e i-c - � 9 )
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: y
>2/(4A21,-L. '' 7�CLGt.f' - ���'=amu. ��
OWNER MAILING ADDRESS: 336 l"-' i i U - --r . or -12_.
OWNER PROPERTY ADDRESS: 94..E-G49 are_
TELEPHONE NUMBER OF CONTACT PERSON: 76,5--174/,53
TAX MAP NO. : Section -517/ Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sig iture of Applicant
RECEIVED BY���w ��4
`��ri Clerk's Office
DATE: MAR X91989
Tem
. . — •
MORRIS CESSPOOL SERVICE INC. / DATE .\
2760 Yennecott Drive
SOUTHOLD, LONG ISLAND, NY 11971 NUMBER
1
(516) 765-3300
TERMS If a receipt is requested,please send a stamped self addressed envelope.
PLEASE DETACH AND RETURN WITH YOUR REMITTANCE $
- - - - -
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