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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERKz. T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER V° O� � Fax (516) 765-1823
01 �1� • 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. 1031 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
INSTALL NEW CESSPOOL SYTEM; FILL IN OLD SYSTEM.
APPROVED WITH THE FOLLOWING STIPULATIONS: MAINTAIN REQUIRED SCHD
DISTANCES FROM BODIES OF WATER AND ADJACENT WELLS; EXCAVATION
INSPECTION REQUIRED.
Name Of Owner LEHNER, JOHN
Mailing Address 1 303 LAKE DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 303 LAKE DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 5 lot 20.000
Cross Street KENNEY ROAD
Building Permit Number Cross Reference:
Issue Date: 8/03/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY i _ ` ` BLDG.DEPT. Hal , 53095 Main Road
TOWN CLERK Z v r rt TOWN OAF SOUTHO)rD P • BOX Y1179k
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REGISTRAR OF VITAL STATISTICS y ��� Fax (516) 765-1823
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 23, 1993
Transmitted herewith is a copy of application No. A1060 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for John Lehren
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 - 3 ' r I 1 EC
TION
DISAPPROVE - , : t '1 :
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OFFICE OF THE TOWN CLERK ,.,'""""'
Town of Southold ���' , 1f Otic
Judith T. Terry, Town Clerk Application No. /did
Town Hall, 53095 Main Road Z 2.; Construction
P. O. Box 1179
Southold, New York 11971 cts , Alteration
Telephone = O �ir ' $10.00 - Residential
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(516) 765-1801 '� 1 , �' $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.
Fee $
DATE ( �
APPLICANT NAME: ,45;ees alev
APPLICANT ADDRESS:
feir
SEPTIC CESSPOOL,/
DESCRIPTION OF 'ROPOSED CONSTRUCTION OR ALTERATION
j011CLile (3c2e— 7z ems.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCT NOR ALTS ATION:
OWNER OF PROPERTY: yr Q xd�
OWNER MAILING ADDRESS: ,3-0S- , a(
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: X.,c_
TAX MAP NO. : Section ‘3"---7 Block 5 Lot 26
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY:
Town lerk's Office
DATE: -]/02
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