HomeMy WebLinkAboutLarsen, John /e�,
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JUDITH T.TERRY ��,o0 Gy�t •
Town Hall, 53095 Main Road
TOWN CLERK t va at P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O .F 1�, Southold,New York 11971
MARRIAGE OFFICER ='yifJ Y � Fax(516)765-1823
RECORDS MANAGEMENT OFFICER .( `,►a �� Telephone(516)765 1800
FREEDOM OF INFORMATION OFFICER �� S I.'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1392 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 02760 1740 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 LARSEN, JOHN F.
Mailing Address 1 9B HIGHLAND ROAD
City St Zip ST. JAMES NY 11780
Property Address 1 1195 ISLAND VIEW LANE
City St Zip GREENPORT NY 11944
Tax Map No. section 57.00 block 2 lot 19.000
Cross Street BAY SHORE ROAD
Building Permit Number Cross Reference:
Issue Date: 9/18/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ,� \� Town Hall,53095 Main Road
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TOWN CLERK t y Z P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Ve kt. 0 Southold,New York 11971
MARRIAGE OFFICER .....yIL 0.. It° Fax(516)765-1823
RECORDS MANAGEMENT OFFICER 491 iii •,•II Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER „„ 'O.°
EH N 0 U E
OFFICE OF THE TOWN CLERK 1 l i
TOWN OF SOUTHOLD IP 15
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office G.DEPT.
TOWI of souTHOLD
DATED: September 15, 1995
Transmitted herewith is a copy of application No. 1444 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Theresa Casamisina •
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.
40P",i, NAle
Signature ar
Date
OFFRCS OF THE TOWN CLERK ,,,'",,,,,
Town of Southold �� ��FFDiK`►-
Judith T. Terry, Town Clerk ;' �l/ Application No. /V
Town Hall, 53095 Main Road : Construction
P. 0. Box 1179 . = •C_
Southold, New York 11971 tests ri Alteration
T
Telephone �,y � ' $10.00 - Residential
(5 6) 765-1801 = 1 1 , $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL JO A) F
Permit No. J r' 6-S
Fee $
DATE )(*)•-i-- / / �
APPLICANT NAME: /` ? C"
\?) APPLICANT ADDRESS: C o j.76/14,WJ� J &Lt ) Iity ft_ l
�/ I7
,r .
SEPTIC CESSPOOL.�J'
DESCRIPTION OF PR POSED O,NSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 76-
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section I Block , Lot /9
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
:ignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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