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ELIZABETH A.NEVILLE $�`Z` yam►` Town Hall, 53095 Main Road
TOWN CLERK I p 1-4
P.O. Box 1179
a el, Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `V. Al t
MARRIAGE OFFICER
O / Fax(516) 765-6145
(516) 765-1800
RECORDS MANAGEMENT OFFICER 1Telephone
FREEDOM OF INFORMATION OFFICER = ��'J '�a�ill
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2170 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner SAFIR, HOWARD
Mailing Address 1 215 EAST 68TH ST., APT. 30E
City St Zip NEW YORK NY 10021
Property Address 1 3445 WICKHAM AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 107.00 block 9 lot 10.000
Cross Street GRAND AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/22/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
iiii Of FOfr ". C)2 / 7 b
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ELIZABETH A.NEVILLE 110=�0 Gy1 Town Hall, 53095 Main Road
TOWN CLERK % o - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ', Southold, New York 11971
Fax(516) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER N.
-.4, ' •' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER --:6:1 41( a01
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: Sept 29, 1999
Transmitted herewith is a copy of application No. 2253 for a Cesspool/
Septic Tank Construction Permit submitted by:
Morris Cesspool for Howard Safir .
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE t
DISAPPROVE
Comments:
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Dated
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OFFICE OF THE TOWN CLERK ,'s
TOWN OF SOUTHOLD ����� `.' _ Application No. o S.--11
ELIZABETH A.NEVILLE,TOWN CLERK d :
P.O.BOX 1179
li ��. Construction /
SOUTHOLD,NEW YORK 11971 0 ./
• tis Alteration
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Telephone ` �Q��' $10.00 -Residential
(516) 765-1801 "( 40r, '* $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee °$
DATE 5p2 ?
APPLICANT NAME: 'a RP-r5. 0-ILV-60-e
APPLICANT ADDRESS: 2 • 0 0,‹
SEPTIC CESSPOOL
DESCRIPTION 0�'ROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR LTERATION:
OWNER OF PROPERTY: /et/ ,57/4//;
OWNER MAILING ADDRESS: /5 en-04-- Cru ' C` 1 - (._ ---t--_
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OWNER PROPERTY ADDRESS: j'1Vt/5— ,/h4A`
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TELEPHONE NUMBER OF CONTACT PERSON: 7S�--- ,)-7)
TAX MAP NO. : Sectio 70 7 Block Lot w
CROSS STREET: Ct",i--•
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
RECEIVED BY: 1- 3, /4 -
4411 ./U-As
A' n lerk's Office
DATE: t
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