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JUDITH T.TERRY �� Town Hall,53095 Main Road
TOWN CLERK t/� Z ; P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O .F , Southold,New York 11971
MARRIAGE OFFICERyifJ v � Fax(516)765-1823
RECORDS MANAGEMENT OFFICER .( * `1►a.•' Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER 41
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1423 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BERNARD FISHER
Address 1 : P. O. BOX 645
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-95-0124
Name Of Owner FISHER, BERNARD
Mailing Address 1 P. O. BOX 645
City St Zip EAST MARION NY 11939
Property Address 1 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 12 lot 4.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 12/07/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY oc ; Town Hall,53095 Main Road
P.O.Box 1179
TOWN CLERK y t 4 t
,� Southold,New York 11971
REGISTRAR OF VITAL STARISTICS 0 aQ�ii Telephone(516)765-1800
Fax(516)765-1823
MARRIAGE OFFICER W
1
RECORDS MANAGEMENT OFFICER 1 *
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 29, 1995
Transmitted herewith is a copy of application No. 1479 for a Cesspool/
Septic Tank Construction Permit submitted by:
Bernard Fisher .
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.
4- tce
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: (s?, /// O9cO/2
Signatur- 4W
is/5--
Dated
OFFICE OF THE TOWN CLERK ,,w,"
��
Town of Southold ���' o VULire;l/
Judith T. Terry, Town Clerk �` y ; Application No./tl/`77
Town Hall, 53 95 Main Road q `` " `' �.[ : Construction
P. 0. Box 1179 �:• -
� mac :
Southold, New York 11971 trl ; �• Alteration
•' $10.00 - Residential ✓
Telephone '40
(516) �
(516) 765-18011 �, ' $25.00 - Non-Residential
• •, , io
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE (// g
APPLICANT NAME: Oviuor-A,
APPLICANT ADDRESS: , r thØ I\ to
sa,0- AOLHoo
SEPTIC CESSPOOL
DjC�RIPTIQNr OF� P OPO�E,�D CONSTRUCTION OR@ �'ERATION
Gwt) QLL�/1 LL,�//ll� 11
1 Y�I w 11
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CON TRUCCTIO OR ALT RATION:
OWNER OF PROPERTY: 19&c4/01 ,_,
OWNER MAILING ADDRESS: Y,.0 • 6eX
/tsl Vii N keel t 195P
OWNER PROPERTY ADDRESS: AVAL) (91-34)1A \J e
TELEPHONE NUMBER OF CONTACT PERSON: 417- 1 ! 1
TAX MAP NO. : Section t 1 I Block Lot 4
CROSS STREET: AlelWkaT C g✓
BUILDING PERMIT NUMBER CROSS REFERENCE:
47744414a, ,0/71464/2.)
Signature of Applicant
RECEIVED BY : .
Town Clerk's Office
DATE: l(
4 T SUFFOLK CO. HEALTH DEPT. APPROVAL
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- �'J f''lAt 5�5__�_93�"� LJ( AVS• S j�VEYED FQ12, STATEMENT OF INTENT
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THE WATER SUPPLY AND SEWAGE DISPOSA_
Przc�P wEt_t , O D P1S-1EF2 SYSTEMS FOR THIS RESIDENCE WIL:
W 1 CONFORM TO THE
�, �� � � t STANDARDS OF TNT.
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I-aANDy .a 4 1 N _ 1 • j SUFFOLK CO. DEPT. OF HEALTH SERVICE.
GANTRY to o j - MATTITUCI� SS) APPLICANT
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SUFFOLK COUNTY DEPT. OF HEALTH
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1995
sEprlc ! \ DATE:
PT 900 GAL.SEPTIC'T 1144 . r...j +4}SArLgs, /2.0"-C1,51. r
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