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JUDITH T.TERRY ` O= Town Hall,53095 Main Road
TOWN CLERK t ti Z ; P.O.Box 1179
1% Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 4 �. Fax(516)765-1823
MARRIAGE OFFICER '�0 aN�1� Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER 1 �` ,�
FREEDOM OF INFORMATION OFFICER , •'•'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1318 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 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 CULLEN, PAT
Mailing Address 1 300 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 300 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 63.00 block 3 lot 5.003
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 4/17/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY :,' L Town Hall, 53095 Main Road
TOWN CLERK p T P.O. Box 1179
ttl Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘VAti.
�. �� Fax (516) 765-1823
MARRIAGE OFFICER ` .aO �� Fax
(516) 765-1801
FREEDOMAGEMENT OFFICER
RECOOF IS NFORMAN OFFICER ��41 � �I,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department Mt 1 3 SE
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 13, 1995
Transmitted herewith is a copy of application No. 1367 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool Service for Pat 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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signatur9/
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OFFICE OF THE TOWN CLERK """"'-
Town of Southold '.����F ULkel0 = Application No./367
Judith T. Terry, Town Clerk s'; (Th
Town Hall, 53095 Main Road ¢ .G ; Construction
P. 0. Box 1179
Southold, New York 11971 �1� � Alteration
. $10.00 - Residential `�-
Telephone ,�
(516) 765-1801
,, ' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE Al,'
APPLICANT NAME: �����,Q,r5 �l rP �tr�-e-
i
APPLICANT ADDRESS:
SEPTIC CESSPOOL-Th(
DESCRIPTION OF P OSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERRAA ION:
OWNER OF PROPERTY: ,t--94 � _•c.eQ _
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 6'3 Block 2 Lot Ste,
CROSS STREET: '194 4'2,
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY:
n Clerk's Office
DATE: v7„2"(4, ,
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