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JUDITH T. TERRY : ''� Town Hall, 53095 Main Road
TOWN CLERK : o rZ : P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �� Fax (516) 765-1823
MARRIAGE OFFICER '' O iso Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 41 rl
FREEDOM OF INFORMATION OFFICERrrr
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1120 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
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 POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES AND BODIES OF WATER. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner CULLEN, LARRY
Mailing Address 1 GOOSE CREEK LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 GOOSE CREEK LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 2 lot 1 .000
Cross Street BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 5/02/94 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY ; Z L : Town Hall, 53095 Main Road
TOWN CLERK : p T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS 'VI ,� • Southold, New York 11971
MARRIAGE OFFICER yQ O� �� Fax (516) 765-1823
',`jj� 1� °6
� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK M
TOWN OF SOUTHOLD I ) .---
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TO: Southold Town Building Department
APR 2 2 1994 -
FROM: Linda Cooper, Southold Town Clerk's OfficeI
p�,
DATED: April 22, 1994
i T 4,�Q OLD
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Transmitted herewith is a copy of application No. A1159 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Larry Cullen
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 INSPECTION
DISAPPROVE - REQUIRED
COMMENTS: ' r,,,,e4 / / ''
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Signatur
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Date
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OFFICE OF THE TOWN CLERK
Town of Southold ". 0 Ffake0 Application No. j �Q
Judith T. Terry, Town Clerk � {
Town Hall, 53095 Main Road •
a Co. ion
P. O. Box 1179 : co • Iteratio.
Southold, New York 11971
$10.00 - Residential
Telephone ' � �►'�
(516) 765-1801 1 1 �` $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION (, 7/c,l/
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ �Q�/
DATE '4 22 //l l /
APPLICANT NAME: %/ ° °
APPLICANT ADDRESS: 2"
SEPTIC CESSPOOL
DESCRIPTION OF PR•;OSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: XA/Ay r)(2 /k4
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OWNER MAILING ADDRESS:i-60$4b( &Od ' c cI
S C-1- •-t,f0 /K
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: XX- ,_, 'J'
TAX MAP NO. : Section 77 Block 7 Lot
CROSS STREET: Y
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sign ure of Applicant
RECEIVED BY: Ai ,
TownC Cler 's Office
DATE: //� QX/
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