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JUDITH T. TERRY : Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK v ►T
REGISTRAR OF VITAL STATISTICS ilk Southold, New York 11971
MARRIAGE OFFICER �� 4 Fax (516) 765-1823
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(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. 751 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : TIMOTHY J. BRIGHAM
Address 1 : 645 WICKHAM AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
REPLACE CESSPOOL IN AN EXISTING SYSTEM.
APPROVED TO REPLACE EXISTING CESSPOOL ( IN PLACE) AS SUBMITTED.
EXCAVATION INSPECTION REQUIRED. CALL BUILDING DEPT. (765-1802) FOR
NECESSARY INSPECTION WHEN READY.
Name Of Owner BRIGHAM, TIMOTHY AND BARBARA
Mailing Address 1 BOX 24
City St Zip MATTITUCK NY 11952
Property Address 1 645 WICKHAM AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 2 lot 27.000
Cross Street PIKE STREET
Building Permit Number Cross Reference:
Issue Date: 9/09/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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P 06 Town Hall, 53095 Main Road
-, �.,'; ;, ,_ ,: P.O. Box 1179
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jSouthold, New York 11971
JUDIl in T.TERRY � j TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD E € C I ,�f `r,�
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To: Southold Town Code Enforcement Officer 161991
From: Linda Cooper, Southold Town Clerk's Office T
Dated: August 16, 1991 ,,, "r4
Transmitted herewith is a copy of application No. 772 for a Cesspool/
Septic Tank Construction Permit submitted by:
Timothy J. Brigham
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.
4"---")"26—
Linda-
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE ��11 p�1 (� n
Comments: or, I„ ctc .d- ( ll CL) Cu.= v„L�c, Off.
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i �� Signature 04.A..- tiL... ..S
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c y� Fy Dated
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Q.FF10E OF THE TOWN CLERK , """
Town of Southold OULA � Application No. 2_2-9.,
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ; +L ; Construction
P. O. Box 1179 ; Alteration
;
Southold, New York 11971
Telephone $10.00 -Residential
(516) 765-1801 = "tel /'g
� $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: (�� ,, 73, 6
APPLICANT ADDRESS: 6; VS--
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION :70Lncc
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: .1 ty10 + 6 `J l 6j4LSA-edS• f (6If9-x7-1(
7
OWNER MAILING ADDRESS: 7b )6 Z ti 6 VS_ GcJ�c�G�"�-,
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OWNER PROPERTY ADDRESS: `S lle r i/L
TELEPHONE NUMBER OF CONTACT PERSON: 2.9y- a jj 2
TAX MAP NO. : Section / (O Block Lot 7
CROSS STREET: cip,, sr;
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BUILDING PERMIT NUMBER CROSS REFERENCE:
/ / /
A ' /.L.� �. ,V /'41 .
' Sign ` % "AID.licant
RECEIVED BY:
n Clerk's Office
DATE: ( i
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