HomeMy WebLinkAboutBecker, John ' ,,,"I,,",
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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK : o T : P.O. Box 1179
tls �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ��� Fax (516) 765-1823
MARRIAGE OFFICER = ., `.6 ,1 Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 1 + 11 .'
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. 1147 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 BECKER, JOHN
Mailing Address 1 BOX 368
City St Zip SOUTHOLD NY 11971
Property Address 1 4415 NORTH BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 3 lot 14.000
Cross Street SHIP'S DRIVE
Building Permit Number Cross Reference:
Issue Date: 6/08/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY :, iC Town Hall, 53095 Main Road
TOWN CLERK : o T P.O. Box 1179
ifs � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS =', •,' Fax (516) 765-1823
MARRIAGE OFFICER _'`^ ,oO �, Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER _ 1 • i�
FREEDOM OF INFORMATION OFFICER =��..,,,,,,,,�I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: June 8, 1994
Transmitted herewith is a copy of application No. A1191 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for John Becker
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.
a"-
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - 4-------- EX
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DISAPPROVE - REI O
COMMENTS: ''
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OFFICE OF THE TOWN CLERK „ ,,,,,,,,
Town of Southold .''', �FF1(K
�' �� �Ol/ . Application No.
Judith T. Terry, Town Clerk � � y”
Town Hall, 53095 Main Road ; Construction
P. O. Box 1179
Southold, New York 11971 �'; Alteration
Telephone �j'
$10.00 - Residential
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(516) 765-1801 Ol l 0' $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
APPLICANT NAME: "#04',i
APPLICANT ADDRESS:
/ /t,V
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
e7}-e-6/4c ) e914//eir(
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: j
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OWNER MAILING ADDRESS: � ' ;' „rip /¢r �/atstkJ `�t%/.JS/11/v\V/I
OWNER PROPERTY ADDRESS: ...7‘r
TELEPHONE NUMBER OF CONTACT PERSON: iter,' "ter
TAX MAP NO. : Section ?/ Block 3 Lot /4/
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
7/1"?'1)
gnature of Applicant
RECEIVED BY:
CIIIVED
Town Cler s Office
DATE: JUN 81994
Sam Wit Settidi
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