HomeMy WebLinkAboutCornwell, Margaret ,,,,,,,ilii
JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK G T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS i ) Southold, New York 11971
MARRIAGE OFFICER O� ��, Fax (516) 765-1823
/t„1 �1D .� Telephone (516) 765-1801
' rr
411
r�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1105 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
Address 1 : 2750 YENNECOTT ROAD
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, AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner CORNWELL, MARGARET
Mailing Address 1 115 HAYWATERS ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 115 HAYWATERS ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 111 .00 block 1 lot 6.000
Cross Street VANSTON ROAD
Building Permit Number Cross Reference:
Issue Date: 4104/94 Judith T. Terry
Southold Town Clerk
(TOWN SFAJ
//O3
G
JUDITH T. TERRY Town Hall, 53095 Main Road
Z
TOWN CLERK o 4-r%
P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘V,4, �. �� Fax (516) 765-1823
MARRIAGE OFFICER ,,��jj �� �� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER �"'V,� •�i�
FREEDOM OF INFORMATION OFFICER � �ii�•
C .
OFFICE OF THE TOWN CLERK Q L5
TOWN OF SOUTHOLD RIR2 5 all
TO: Southold Town Building Department TOWN OF D•EPT.• •
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 24, 1994
Transmitted herewith is a copy of application No. 1142 for a Cesspool/
Septic Tank Construction Permit submitted by:
Morris Cesspool Service for Margaret Cornwell
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
EXCAVATION INSPECTION
REQUIRED
Linda J. Cooper
I have reviewed the application and location map of the project cited above -
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: � �
4.4..1/4474_ .04/47/;616,097,-/
RECMVED _ �
Signature
MAR 3 1 1994 3/.3/ lX
Dated
Town Clerk Southold
OFFICE OF THE TOWN CLERK ,s"'',"" --
Town of Southold `O _ Application No./i�L.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. O. Box 1179Alteration 0-
Southold, New York 11971 ;'
Tele hone = ,� ; $10.00 -Residential
P
(516) 765-1801 - 1 * ' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /J
DATE pi J�" '
APPLICANT NAME: /1e,/ �, if?e
APPLICANT ADDRESS: 2 Co
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A,fO &1-iy1.�/
s:�//
OWNER MAILING ADDRESS: //X t "4) 4C% ,
Ce: t J 4
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /// Block / Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Oeyee,,. /" wei
5' nature of Applicant
RECEIVED BY: 'V t
Town Clerk's Office
DATE: RECIIVID
MAR 2 41994
town Clair Southold
d.
"••••
Cieff i 4'
illif S
!
f2 ,0
,
1,
______