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JUDITH T. TERRY t� Town Hall, 53095 Main Road
TOWN CLERK t T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER %0 O�- ��,e. Fax (516) 765-1823
°TAW 411 ,1D 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. 946 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 SOUTHODL NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS AMENDED. HOLD 10' SEPARATION BETWEEN POOLS. EXCAVATION
INSPECTION REQUIRED. CALL FOR AN APPOINTMENT (765-1802)
Name Of Owner EDSON, GRACE
Mailing Address 1 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 2 lot 16.000
Cross Street PEQUASH AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/22/92 Judith T. Terry
Southold Town Clerk
LIMN SEAL'
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JUDITH T. TERRY L Town Hall, 53095 Main Road
TOWN CLERK : p r= P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
tri Southold, New York 11971
MARRIAGE OFFICER V0A. �- Fax (516) 765-1823
_ ,�� ,� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: December 9, 1992
Transmitted herewith is a copy of application No. A 973 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Grace Edson
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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: 4, M I 'a Ast.lt:ios.e\
UALAlu."-\ Q ck.Q. ),S14.4, k.)
DAL,,,,LDEC 18 199?
Signature
Town Clerk Routtiolit
o
Date
OFFICE OF THE TOWN CLERK
Town of Southold �FFOIk
Judith T. Terry, Town Clerk ,`44, � - Application No. 9 7.3Town Hall, 53095 Main RoadL Construction
P. 0. Box 1179 ; i T
Southold, New York 11971 tl'� Alteration
Telephone ,v'0,�O �����,� $10.00 - Residential
(516) 765-1801 .. 1 l' ,, !' $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 Pigz., V /
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APPLICANT NAME: p( 5-5-yerA°
APPLICANT ADDRESS: 2 Q 2/;‘ ,1/1/74--r-.60 rre /j 7
roti lzy 11 7/
SEPTIC CESSPOOL
DESCRIPTION OF/PROPOSED CONSTRUCTION OR ALTERATION
/i C ��: e-irtp,-eJf
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: -e �
OWNER MAILING ADDRESS: ;. J'
�d -tt,60 )„ e7/
OWNER PROPERTY ADDRESS: t&fr
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TELEPHONE NUMBER OF CONTACT PERSON: 7‘cr--__-?,7C) '
TAX MAP NO. : Section /O Z Block Z- Lot /S
CROSS STREET: (71) ,(-/__664--7A---
BUILDING
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BUILDING PERMIT NUMBER CROSS REFERENCE:
;49 k/ (1-2,,,,,
0--,,,
ignature of Applicant
RECEIVED BY: C.( v
TownCferk's Office
DATE: /0/0-2.-----'
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