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JUDITH T. TERRY
Town Hall, 53095 Main Road
TOWN CLERK : p T : P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER '_740 4%6 �� Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER 14
FREEDOM OF INFORMATION OFFICER � ,��of'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1218 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 DAPER, VIRGINIA AND LINGO
Mailing Address 1 6 WEST DRIVE
City St Zip EDISON NJ 0820
Property Address 1 44255 MAIN ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 75.00 block 1 lot 21 .000
Cross Street PECONIC LANE
Building Permit Number Cross Reference:
Issue Date: 10/13/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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ift' Town Hall, 53095 Main Road
JUDITH T. TERRY : � < ;
TOWN CLERK : =v Fr, P.O. Box 1179
Vs Southold, New York
11971
REGISTRAR OF VITAL STATISTICS ‘'`-‘106 �� Fax (516) 765-1823
MARRIAGE OFFICER _ ``��jj�� 0� .�� Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER -7"R/J i�
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK 0 Q w
TOWN OF SOUTHOLD
TO: Southold Town Building Department _Ll_� 2
FROM: Linda Cooper, Southold Town Clerk's Office
BLD .DEPT
DATED: September 28, 1994
TOWN OF SOUTHOLD
Transmitted herewith is a copy of application No. A1262 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Virginia Draper and other .
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 -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Aiir# ,P,'
Signature
/47/ 1
Date
- OFFICE OF THE TOWN CLERK ,,,,,,C: ��
Town of Southold " FFl
Judith T. Terry, Town Clerk ;' G
Application No.
Town Hall, 53095 Main Road ; � Construction
P. 0. Box 1179
o Alteration
Southold, New York 11971 cn
Telephone ,�y� .�0 ��' $10.00 - Residential
(516) 765-1801 = 1 * ,, �'� $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ •
DATE Crfr 7Y9y
APPLICANT NAME: Mee_f
APPLICANT ADDRESS: I
SEPTIC CESSPOOL V
DESCRIPTION F PROPOSED CONSTRUCTION OR ALTERATION
eA01:,° °,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: G/�,c-,:r Ze
OWNER PROPERTY ADDRESS: of
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 75" Block / Lot ,?/
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
j
Alen- Signature of Applicant
RECEIVED BY: 4C-1(a4 6:"-e°4
Town Clef k's Office
DATE: / _ / - y
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