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JUDITH T. TERRY ; Z L Town Hall, 53095 Main Road
TOWN CLERK ` G p.m
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Cly �, Southold, New York 11971
MARRIAGE OFFICER �v �. �� Fax (516) 765-1823
=='`O� ��� 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. 755 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : EUGENE BURGER
Address 1 : 2515 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
BARN WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 11/9/90.
Name Of Owner BURGER, EUGENE
Mailing Address 1 2515 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 2515 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 84.00 block 4 lot 5.000
Cross Street COX LANE
Building Permit Number Cross Reference:
Issue Date: 9/19/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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4 1991 ` f_J -- .{
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y TM 1 Town Hall, 53095 Main Road
Nk ' +''''.- P.O. Box 1179
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Southold, New York 11971
JUDITH T.TERRY q 'r
r1. ,.%� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: September 4, 1991
Transmitted herewith is a copy of application No. 776 for a Cesspool/
Septic Tank Construction Permit submitted by:
Eugene Burger .
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE x
DISAPPROVElilk
Comments: .i,., n�c4;n tv Q1 Q0n
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RECEIVED I:fr
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SEP 0 f 1'=` Signature
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Town Clerk Southold Dated
OFFICE-60F THE TOWN CLERK ,,'",,•""
Town of Southold �.0"cegUr`i
Judith T. Terry, Town Clerk ;' �� �l/ Application No.
Town Hall, 53095 Main Road ;IConstruction
P. O. Box 1179
Southold, New York 11971 I �'W$
Alteration
Telephone �,� $10.00 - Residential
(516) 765-1801 — .1
'� $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 es.„04-3 , ,,,, ,
APPLICANT NAME: V' re./ f))V{c C
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APPLICANT ADDRESS: 2 Y1� �� `0&
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: G1 e
OWNER MAILING ADDRESS: S)0‘,0"---<-
OWNER
PROPERTY ADDRESS: S Ct. VrJ.
TELEPHONE NUMBER OF CONTACT PERSON: -75q-c-7,17
TAX MAP NO. : Section .geli Block q Lot
CROSS STREET: &I, I
BUILDING PERMIT NUMBER CROSS REFERENCE:
-1/17117)
Signature of ApOicant
RECEIVED BY: „,de ,�_�..G
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DATE: ? 3 �j
SUFFOLK CO.HEALTH DEPT.APP*OV t X, r
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... . 44R.94�`17 4 OLVE CONN. :•G7.Q5,T . .. „ =..,,,.., +!' r STATEMENT OF INTENT r
_...r—AT:COX'S LANE --,,, - r•-TESSL.HOLE'EL•577 ;� -` t ``
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_ , , f THE WATER SUPPLY AND SEW AGE{lISPOSJIL
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;*-/ 1 SYSTEMS FOR 7H15 RESIDENCE<'MfILL
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