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ELIZABETH A.NEVILLE iP /yA Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
4 ti Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER ` Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER :170A ,
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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. 1971 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ROYSTON, P. RIND
Address 1 : 1375 MEDAY AVENUE
City St Zip MATTITUCK NY 11952
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 RIND, ROYSTON P.
Mailing Address 1 1375 MEDAY AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 1375 MEDAY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 9 lot 4.000
Cross Street HOWARD AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/16/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ° Gy h`Z� Town Hall, 53095 Main Road
• TOWN CLERK t1 p _r4 % P.O. Box 1179
yZ'% Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax��t Fax (516) 765-1823
MARRIAGE OFFICER : ?i
RECORDS MANAGEMENT OFFICER %_..-IJO! 4.00
�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER �•' I����
•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 16, 1998
Transmitted herewith is a copy of application No. 2048 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Ray Nine for Rind
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.
S. nature\6(4. -----
,lit 6 /4T
Date
OFFICE OF THE TOWN CLERK '. .F ULi'
TOWN OF SOUTHOLD � ��FF�IKcoG'_ Application No. , o
F1 I7ABETH A.NEVIIJ.F,TOWN CLERK
/04
P.O.BOX 1179 ; . Construction
SOUTHOLD,NEW YORK 11971 : O T
z. • Alteration
Telephone oO �Q���/ $10.00 -Residential
(516) 765-1801 '. 41
'� $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
BcrRi9(-7 Ail A DATE C��/ - / , /99
APPLICANT NAME: ay S/'7j._) 1, /?jam 3
(i_
APPLICANT ADDRESS: /J 2i / -.—,(3/9/ j j/e.--`�
/ ,, T77'vciv-C /0, F // .13-2._
SEPTIC CESSPOOLK
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
W6/2/9- L-r-- ---.-----?-4.5/7/07 -sys/2-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST UCTION OR ALTERATIO
OWNER OF PROPERTY: K/,Y 57"piU /? /C}L)
OWNER MAILING ADDRESS: /_j 2jr /i/Z-7-44 j -vL�
, 7-7'7 ' / _), /1 � 3 Z
OWNER PROPERTY ADDRESS: ,j'42/ 7 2--r
TELEPHONE NUMBER OF CONTACT PERSON: 2 J2k - c� 2
TAX MAP NO. : Section //3 Block Lot
CROSS STREET: hie) w/9-/' / %zC.&!---
BUILDING PERMIT NUMBER CROSS REFERENCE:
c/ I
Sjgnature of Applicant
RECEIVED BY: ,eie.,,
Town Clerk's Office
DATE: ll le/ci
Celw"
Realty
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Main Road/Celic Center,PO Box 786, Mattituck, New York 11952 (516) 298-8000, FAX 298-8133
I 1
RIND...APPROX. DIMENSIONS
028'
I
_ .
A., ("4"
One & One-half Story
r twG-
Living Area: 2196 sq. ft.
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anew 96 equate 9i'
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