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ELIZABETH A. NEVILLE I/*** �y�,; Town Hall, 53095 Main Road
TOWN CLERK • p _-4 P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS �y ,• Southold, New York 11971
MARRIAGE OFFICER : Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER aO�'1�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER — ' * oil
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2081 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 OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner SUROZENSKI, DAVID
Mailing Address 1 39765 COUNTY ROAD 48
City St Zip SOUTHOLD NY 11971
Property Address 1 39765 COUNTY ROAD 48
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 9 lot 30.001
Cross Street KENNY'S ROAD
Building Permit Number Cross Reference:
Issue Date: 5/25/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ',�
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Town Hall, 53095 Main Road
TOWN CLERK Z c P.O.:�c Box 1179
c Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS v- Fax (516) 765-1823
MARRIAGE OFFICER • ® �' Tlhone(516) 765-1800
RECORDS MANAGEMENT OFFICER Telephone
FREEDOM OF INFORMATION OFFICER • ��� jig `t.s.
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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: May 18, 1999
Transmitted herewith is a copy of application No. 2169 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
David Surozenski by Morris Cesspool
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.
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Date
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OFFICE OF THE TOWN CLERK ,�'=``��Ot jre'.
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TOWN OF SOUTHOLD ,�' � Q*GI Application No.0J 6 q
ELIZABETH A.NEVII.I.F,TOWN CLERK �7P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971
^' Alteration //'
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Telephone w,j� � , $10.00 -Residential !/
(516) 765-1801 �l � ,�' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. a(),
Fee $
DATE /117 ( 9Y
APPLICANT NAME:
APPLICANT ADDRESS: 02 76d
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SEPTIC CESSPOOL-
DESCRIPTION OF ROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: j?,9.'i'?
OWNER MAILING ADDRESS: 3T 7(os "re YO
OWNER PROPERTY ADDRESS: 391(0S C,-��.1 d L)
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TELEPHONE NUMBER OF CONTACT PERSON: 7d.5"-
TAX MAP NO. : Section 5-9 Block 9 Lot J ..
CROSS STREET: Ke yl v 5 -f Ci •
BUILDING PERMIT NUMBER CROSS REFERENCE:
/ Signature of Applicant
RECEIVED BY: "b1-
Town Clerk' ffice
DATE: 49-11(/).11
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