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ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hal], 53095 Main Road
P.O. Box 1179
Southold, New York 1.1971
Fax(516)765-1823
Telephone (516) 765-1800
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 88 N Residential Non -Residential X
Fee $ 25.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HENRY BREMER
Address 1: PO BOX 790
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF GREASE TRAP AND NEW SEPTIC TANK TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner FEERICK, RAYMOND
Mailing Address 1 PO BOX 405
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City St Zip AQUEBOGUE NY 0000
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Property Address 1 11155 MAIN ROAD
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City St Zip MATTITUCK NY 11952
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Tax Map No. section 142.00 block 2 lot 22.000
Cross Street LEGION AVENUE
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Building Permit Number Cross Reference:
Issue Date: 3/17/99
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Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
T� OF SOUTHOLD
TO: Southold Town uillding Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 17, 1999
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
Transmitted herewith is a copy of application No. NR2123 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Henry Bremer
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 thefolio ing recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signat r
31►-)�Ry
Date
O'FFICg OF THE TOWN -CLERK
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone
(516) 765-1801
Permit No.
TOWN OF SOUTHOLD
T
Application No.
Construction
Alteration
$10.00 - Residential
5.00 - n -Residential
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
f (.) r
CONST RUC'T ION or ALTERAViON PERMIT
SEFIT!C TANK or CESSPOOL
9W_r.1r_nMft
MAR 1 7 1999
[own CWk Utnow
Fee
DATE_
APPLICANT NAME:
APPLICANT ADDRESS: -)o r2 7
SEPTIC i�;ESSPOOL-__
DF�CPIIPT!ON OF PROPOSED CONSTRUC.'TION OR ALTERATION
LOCATION MAP: Must be attached herpt--.-) before permit inay be issued.
LOCATION OF PROPOSED (,',0NSTR1_('Tl(.)N 0111 A!.TC__PA1'lON:
OWNER OF PROPERTY:r AJd e -ee I'c- K_
OWNER MAI'L!'NIG ADDPESS:-
-
OWNER PROPERTY ADDRESS: jjIs--f
.TELEPHONE NUMBER OF CONTACT PERSON. /70 /,5721
TAX MAP NO, - Section_f Iilur_I,
CROSS STREET:
— -1!3. -_ - - 40e
BUILDING PERMIT NUMBER CROSS
nature of Applicant
RECEIVED BY: z
Town C �
Town C �tl's Office
DATE: er
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