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-ELIZABETH A.NEVILLE t�`Z' yam►` Town Hall, 53095 Main Road
TOWN CLERK p 1.4 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � ,' Southold, New York 11971
MARRIAGE OFFICER Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER #* 0 � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER = 'I I '-0,
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2087 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ANN CASSIDY
Address 1 : 270 PARK AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
REPLACMENT CESSPOOL IN AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner CASSIDY, ANN
Mailing Address 1 12854 PARAPET WAY
City St Zip HERNDON VA 20171
Property Address 1 270 PARK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 8 lot 27.000
Cross Street BUNGALOW LANE
Building Permit Number Cross Reference:
Issue Date: 5/25/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
OIL
f ELIZABETH A.NEVILLE 1 * a t�j Town Hall, 53095 Main Road
TOWN CLERK to c �; P.O. Box 1179
k y 2 q Southold, New York 11971
REGISTRAR OF VITAL STATISTICS `r
MARRIAGE OFFICER Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER N.4% %v Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER % of * �`/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: May 21 , 1999
Transmitted herewith is a copy of application No. 2175 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Ann C. Cassidy .
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 folio ing recommendation:
APPROVE
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
ignatur V.- -'.. 4.-"C-------
c/?--f (Q ei
Date
OFFICE OF THE TOWN CLERK 11
�J��
�, TOWN OF SOUTHOLD ;' �"��Q Application No.. ( 7,5
ELIZABETH A.NEVILLE,TOWN CLERK ,'4 -
P.O.BOX 1179 Z .L Construction
SOUTHOLD,NEW YORK 11971 : = Z
1 Alteration
Telephone 04% Qom,/, $10.00 - Residential
(516) 765-1801 ".. t ��
_ � '� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. cZ)8 7
Fee $
DATE ...5-;4 //,,
APPLICANT NAME: `7/////i � ,A2zS /d
APPLICANT ADDRESS: 0V 70 / '
, , " /7ve//z1
SEPTIC CESSPOOL 4/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
'ei.o/e 1__-- ,t// 7;-)( // 7
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /9/1///ii (i4-6-- -/ a/
OWNER MAILING ADDRESS: ,/i6� /94 T Z(_)/9--7
/e,��a A/ ,,S/7/
OWNER PROPERTY ADDRESS: ,(2 72 ./. 4,2X /-e
/7-7/32-7-7777;c)( �'P7 i/9,, ,--;?
TELEPHONE NUMBER OF CONTACT PERSON: 7 3 — - /7 //„.3
TAX MAP NO. : Section ./., Block 7 Lot c7
CROSS STREET: oe G//1/16-',$/ a-)' A/74'0- 'ie /,49/W GaXi. X
BUILDING PERMIT NUMBER CROSS REFERENCE:
- -c..---7,..--
Signature of Applicant
RECEIVED BY :
Town Clerk's Office
DATE:
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