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JUDITH T. TERRY : '' L Town Hall, 53095 Main Road
Z ' P.O. Box 1179
TOWN CLERK tG T '
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
� y Fax (516) 765-1823
MARRIAGE OFFICER0i. 0�1�� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 925 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RAYMOND NINE
Address 1 :
City St Zip 00000
Descripton of Proposed Construction or Alteration
ADDITON OF AN OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. REMOVE ABANDONED CESSPOOL TO LANDFILL. HOLD
10'0" SEPARATION TO EXISTING. EXCAVATION INSPECTION REQUIRED. CALL
FOR NECESSARY APPOINTMENT.
Name Of Owner AVENT, CARL
Mailing Address 1 FIRST STREET
City St Zip NEW SUFFOLK NY 11956
Property Address 1 FIRST STREET
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 8 lot 16.000
Cross Street KING STREET
Building Permit Number Cross Reference:
Issue Date: 10/22/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : L ; Town Hall, 53095 Main Road
TOWN CLERK :
'OFFICE OF THE TOWN CLERK c��-Foik
Town of Southold �D ; ta-
Judith T. Terry, Town Clerk �: y Application No. 9s5-61Town Hall, 53095 Main Road c=9
l} Construction v
P. O. Box 1179 f� t
Southold, New York 11971 �••• Cyt r Alteration
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Telephone 1 re "c° Residential(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. q5 D
Fee .$
DATE /a /2-/ /
APPLICANT NAME: G 4 1 L 41/,6-iv)-
APPLICANT
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APPLICANT ADDRESS: f 11'fT S T/j E 6"/
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SEPTIC CESSPOOL 7
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION JvE I,v evEReco„,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: G/9 iQ L,yA�
OWNER MAILING ADDRESS: f
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: c'�C
TAX MAP NO. : Section / 1 7 Block Lot
CROSS STREET: A jy S PTF
BUILDING PERMIT NUMBER CROSS , G;7
REFERENCE:-.
i 'na uie of AppJi ant
RECEIVED BY: /V---/ A `�
Town Clerk's Office
DATE: /'�� / _
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