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'' ELIZABETH A.NEVILLE ► yTown Hall, 53095 Main Road
TOWN CLERK ► c P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v. ivy � Southold,New York 11971
MARRIAGE OFFICER Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER =Wie a0./ Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER = ' .1►,is1
•0�,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 14, 1999
Transmitted herewith is a copy of application No. NoJ#1 for a Cesspool/
Septic Tank Construction Permit submitted by:
Town of Southold/Solid Waste Management •
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 recgmmendations:
APPROVE
DISAPPROVE
Comments:
AQ
ignature
9
Dated
OFFICE OF THE TOWN CLERK ,�'/ //////",,,,/,'
TOWN OF SOUTHOLD ,1' O��FFD�KC(f' Application No.
" ELIZABETH A.NEVILLE,TOWN CLERK �r ?,%41
P.O.BOX 1179Construction
SOUTHOLD,NEW YORK 11971 T
23 Alteration
Telephone - ..if' Q�;� $10.00 -Residential
(516) 765-1801 ' ' 1 �� �
��' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE J a.- Iy -q 1
APPLICANT NAME: (wN o,c z_r)
APPLICANT ADDRESS: CavinrY *i 4Bt.lig 'Z Zi9-c N S L,9Nc
Cu r c ko(c u i �( it q 3c
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
�0,5 7724.4c 7-. o,N O SS P i c /c 6S5 s y s
/`e(L n)ttt) OFrzc� ?-R�}i Lc12
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1 o&cif of 64:7-//o )
OWNER MAILING ADDRESS: ,S3c)'14 PARTN A{,
'uru-OLP , N \l 1Pi7 �
OWNER PROPERTY ADDRESS: „SA wiz- '95 i4 60i-=cAA/7-
TELEPHONE
n '7TELEPHONE NUMBER OF CONTACT PERSON: 7 34)- 76
$S
TAX MAP NO. : Section /OGe Block aeio, Lot 01 - 17- 3
CROSS STREET: Z,63c 1-A/VC
BUILDING PERMIT NUMBER CROSS REFERENCE: j1lAt
J ✓i,-ccs •✓�
Signature of Applicant
RECEIVED BY: ����±±
Town C�Itc't 41Uai
DATE:
14
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