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ELIZABETH A. NEVILLE 04.0 'y�; Town Hall, 53095 Main Road
TOWN CLERK ; H ; P.O. Box 1179
,y, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `Q � ,�� Fax (631) 765-6145
MARRIAGE OFFICER teyl,
RECORDS MANAGEMENT OFFICER ___"'/Ql &foo,
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2349 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JONATHAN MUDD
Address 1 : 22540 MAIN ROAD
City St Zip ORIENT NY 11957
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner POGGI, RICHARD
Mailing Address 1 22540 MAIN ROAD
City St Zip ORIENT NY 11957
Property Address 1 1740 VILLAGE LANE
City St Zip ORIENT NY 11957
Tax Map No. section 24.00 block 2 lot 18.000
Cross Street ORCHARD STREET
Building Permit Number Cross Reference:
Issue Date: 6/20/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE •
Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Q �� Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �'y?Ipl 40.1 Os
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ °1,.
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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: June 19, 2000
Transmitted herewith is a copy of application No. 2438 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Jonathan Mudd for Richard Possi
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.
ignature
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Date
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, ���FFOFFICE OF THE TOWN CLERK ,t�' OLKC': , ,/
TOWN OF SOUTHOLD %'s_O� 4Q. .. Application Nc.,2 U
EUZABEIH A.NEVILLE,TOWN CLERK • V
P.O.BOX 1179
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. Construction
SOUTHOLD,NEW YORK 11971 v rr+
N Alteration
•Telephone \O,j� / $10.00 -Residential
(63t) 765-1800 __4962 4/lb, �' $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$
DATE J
APPLICANT NAME: -__Innf�-+4i i r uCO-
APPLICANT
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APPLICANT ADDRESS: 22910 OA,q: ,iO 11J o c r t9-L,-1 'vl
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SEPTIC p( CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION f
Ex,'S-1- .� 51
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ' c___16 ,,Arc) ®oSS',
OWNER MAILING ADDRESS: 22S-40 ('71f;,4 U 'd A(i
)19
OWNER PROPERTY ADDRESS: C7 ya (. lik4-sr._) L y�-,(
o(r1 -3-v4 i f 4 S 7
TELEPHONE NUMBER OF CONTACT PERSON: ��� �-
TAX MAP NO. : Section 0---1- Block C ')--- Lot 13
CROSS STREET: 0�-e ,
BUILDING PERMIT NUMBER CROSS REFERENCE:
- I,
Signature of Applicant
RECEIVED Y:
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To QC's JO Bice
DATE: / v <✓
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