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JUDITH T. TERRY �<
Town Hall, 53095 Main Road
TOWN CLERK : o T P.O. Box 1179
�� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = Fax�� Fax (516) 765-1823
MARRIAGE OFFICER ' ' O �� Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER -="W '4/I' •.
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. 43 N Residential Non-Residential X
Fee $ 25.00 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
SEPTIC TANK AND CESSPOOL FOR EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
PROPERTY LINES, AND BUILDINGS. PROVIDE STEEL COVERS TO SCHD
SPECIFICATIONS. EXCAVATION INSPECTION REQUIRED.
Name Of Owner SOUTHOLD IGA
Mailing Address 1 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 61 .00 block 4 lot 25.001
Cross Street YOUNGS AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/02/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY ; •.4. : Town Hall, 53095 Main Road
TOWN CLERK z p T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICSs gr
• � Southold, New York 11971
MARRIAGE OFFICER yQ O� •�', Fax (516) 765-1823
�,`j�l �1D '�� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK ,z' .„
TOWN OF SOUTHOLD ,,
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 23, 1993
•
Transmitted herewith is a copy of application No. ' A1103 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Southold IGA .
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 - EXCAVATION INSPECTION
DISAPPROVE - REQUIRED
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OFFICE OF THE TOWN CLERK ,,,,,,,,,,
Town of Southold ��' ,C��FF���(`►.
Application No. //63
Judith T. Terry, Town Clerk Gy
Town Hall, 53095 Main Road 41 Construction
P. O. Box 1179
Southold, New York 11971 �� Alteration
Telephone $10.00 - Residential
(516) 765-1801 =y�0141 #00., $25.00 - Non-Residential, 3
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. HO
Fee $
DATE f) // _
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APPLICANT NAME: ¢ � �J ( _ie
APPLICANT ADDRESS: mac)
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SEPTIC 1/CESSPOOL Z2
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 7 li�� Gc9
OWNER MAILING ADDRESS: 17---
OWNER
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section d6 ( Block 4/ Lot 5 /
CROSS STREET: IyAA.—t---1-1—cio
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Applicant
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RECEIVED BY: /0 )
Town Clerk's Office
DATE:
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