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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK ;p rZt P.O. Box 1179
tri Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = V) 47. **
Fax (516) 765-1823
� Tel
MARRIAGE OFFICER _ �� ) ,Iephone (516) 765-1801
RECORDS MANAGEMENT OFFICER _'��(/1 P e°
FREEDOM OF INFORMATION OFFICER ��0•„,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1213 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 AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner COKKINOS, ATHENA AND IRENE
Mailing Address 1 31 76 46TH STREET
City St Zip LONG ISLAND CITY NY 11103
Property Address 1 7155 SKUNK LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 4 lot 31 .000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 9/26/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
i f / -) .
;/ L Town Hall, 53095 Main Road
NTOWNN C RKITH T. Y : =o r= P.O. Box 1179
` Vs W$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = ' Fax (516) 765-1823
MARRIAGE OFFICER ,�j� 0O •�� Telephone (516) 765-1801
_
RECORDS MANAGEMENT OFFICER _ _"K/1 J /�r�r►�
FREEDOM OF INFORMATION OFFICER ��„iii
OFFICE OF THE TOWN CLERK --51RIMM.—
TOWN OF SOUTHOLD ,}
19 1994 ,
TO: Southold Town Building Department f
BLDG.DEPT.
FROM: Linda Cooper, Southold Town Clerk's Office TOWN OF SOUTHOLD
DATED: September 16, 1994
•
Transmitted herewith is a copy of application No. A1258 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for A. Cokkinos .
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 - [. ' EXCAVATION %NSPEECTt4N
DISAPPROVE - REQUIRED
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
RECIVED
•$ / .7-.4---‘
6;i6, ,
2 x 1994 Signa ure
TOM cry Southold Vaiff/9‘9
Date
OFFie"E OF THE TOWN CLERK ,,,,,,
Town of Southold ...°14001.% /
Town Clerk Application No/ a J`
Judith T. Terry, 4' ..
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 i * i Alteration z.
Southold, New York 11971 ;` J-
Telephone
_
$10.00 - Residential
����
(516) 765-1801 Ol Jilt 1, 7' $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 (.5f4 / /( 7
APPLICANT NAME:
#��� ` ,
APPLICANT ADDRESS: (A([0 / , / ."
—(2_ 1 A' 7
SEPTIC CESSPOOL
DESCRIPTION OF P POSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION ORS/ RATION:
OWNER OF PROPERTY: � ,:994 S ) 7:-71/ N;en
OWNER MAILING ADDRESS: "XJ j4" t /-\_`
OWNER PROPERTY ADDRESS: 3 / 7 6 y( Ate_- , ..i.4. 2
: - A. -/ ' w
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /0 (/ Block ci Lot 3 7
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE: /1- 7./ i.C,
i ). ;IfirS'
of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
iZo