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JUDITH T. TERRY < : Town Hall, 53095 Main Road
TOWN CLERK ,t T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS irS
Southold, New York 11971
MARRIAGE OFFICER
%O 1- Fax (516) 765-1823
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(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1047 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
INSTALLATION OF AN ADDITIONAL OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED. MAINTAIN REQUIRED SCHD SETBACKS FROM PROPERTY LINES,
BUILDINGS, WELLS, ETC. EXCAVATION INSPECTION REQUIRED.
Name Of Owner DIMON, KENNETH
Mailing Address 1 6200 KNAPP PLACE
City St Zip GREENPORT NY 11944
Property Address 1 6200 KNAPP PLACE
City St Zip GREENPORT NY 11944
Tax Map No. section 34.00 block 3 lot 10.000
Cross Street BAILEY AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/06/94 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY ;
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OFFICE OF THE TOWN CLERK ,.,,"""
Town of Southold �,�'��s�FFOIK`+.=_ f
Town Clerk ,' vl/ Application No./ Q 7�
Judith T. Terry, ,�
Town Hall, 53095 Main Road %'..t.:"-: Construction e-----
P. O. Box 1179 z ` Alteration
Southold, New York 11971 •tr's W
Telephone 0 Q���'� $10.00 - Residential '---
(516) 765-1801 `-*At
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- � ,, ,i $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
ID' ��
Fee $
DATE , i) ,74 .Ya /l /g
APPLICANT NAME: ,t ,D/ei& :: xJ
APPLICANT ADDRESS: 27 o9ff � 7cco P �.�
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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: /<c,,J J
OWNER MAILING ADDRESS: H2O ,1-41prgo ' i1 (,C•
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 3tfhhs "Ze7-2-,--‘
TAX MAP NO. : Section Y/ Block Lot /O
CROSS STREET: 4c,e7
BUILDING PERMIT NUMBER CROSS REFERENCE:
0
, - - Signature of Applicant
RECEIVED BY: k
Town Jerk's Office
DATE: 9 -JO - ?J
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10
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