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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : o T P.O. Box 1179
EP Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO c Fax (516) 765-1823
MARRIAGE OFFICER `^ �O �� Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER — 1 * ►'
FREEDOM OF INFORMATION OFFICER ' �i�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1121 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITON OF AN OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQURIED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, AND BODIES OF WATER. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner EPSTEIN, SAM
Mailing Address 1 GOOSE CREEK LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 GOOSE CREEK LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 8 lot 5.001
Cross Street BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 5/02/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : v T P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS VI �� Southold, New York 11971
MARRIAGE OFFICER yQ ' o�, Fax (516) 765 1823
=-�'�1 �1D O0 0. Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
I-) II�
TOWN OF SOUTHOLD > ,
APR 22 ON
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office BLDG.DEPT.
TOWN OF SOUTHOLD
DATED: April 22, 1994
Transmitted herewith is a copy of application No. A1160 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Sam Epstein
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.
y ciy,ct�,-
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - !� EACMATION INSPECT°
REQUIRED
DISAPPROVE
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OFFICE OF THE TOWN CLERK
Town of Southold �'� C��FWre '- Application o. / ((o
Judith T. Terry,. Town Clerk G
Town Hall, 53095 Main Road ; . ; Construction
P. O. Box 1179 ,' APIW
Southold, New York 11971 in 4E
Telephone _ �, � i $10.00 - Residential
(516) 765-1801 , $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 A(p 2 /Wc.
APPLICANT NAME: •47GR,O. C1 (,
APPLICANT ADDRESS: -2 7‘o
SEPTIC CESSPOOL
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: S-)742-41 ‹ '/!/
OWNER MAILING ADDRESS:Roc /001-' o dA'{:'
wry
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 76c-
TAX MAP NO. : Section 7? Block Fk Lot i^-
CROSS STREET: 1J /1
BUILDING PERMIT NUMBER CROSS REFERENCE:
,79/7aw,Signature of Applicant
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RECEIVED BY: li-/ l
Town Clerk's Of
DATE: t.1Q1
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