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JUDITH T. TERRY z Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .` Southold, New York 11971
MARRIAGE OFFICER
it Fax (516) 765-1823
Jett 1":01.
Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 971 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GEORGE HAGEMEISTER
Address 1 : C/O GENERAL DELIVERY
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
CESSPOOL SYTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 3/30/93.
Name Of Owner HAGEMEISTER, GEORGE & MARYJANE
Mailing Address 1 C/O GENERAL DELIVERY
City St Zip MATTITUCK NY 11952
Property Address 1 LITTLE NECK ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 9 lot 13.002
Cross Street WILSON ROAD
Building Permit Number Cross Reference:
Issue Date: 4/15/93 Judith T. Terry
-� Southold Town Clerk
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JUDITH T. TERRY ; Pei .G Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS V � Southold, New York 11971
Fax (516) 765-1823
t.
MARRIAGE OFFICER ® �' •r r
__ ,y®1 '' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 1, 1993
Transmitted herewith is a copy of application No. 998 for a Cesspool/
Septic Tank Construction Permit submitted by:
George and Mary Jane Hagemeister _ .
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 recommendations:
APPROVE X _
DISAPPROVE r(
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-OFFICE OF THE TOWN CLERK c, "Q,
Town of Southold G��, ` ��✓.-
Judith T. Terry, Town Clerk �;' y Application No. C/�
Town Hall, 53095 Main Road � !•�,�5., ,� /'P. O. Box 1179 �'� T54 ,1
Construction
Southold, New York 11971 t;5.% Alteration
Telephone ifa !y 1 Residential V
(516) 765- 1801 „rffij
Non-Residential
TOWN ,OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
• for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
•
Fee .$
DATE 0 /0 3
APPLICANT NAME:
•
APPLICANT ADDRESS: 61,4
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SEPTIC CESSPOOL• DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /? -
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: GQ®..-, c- - . i-r
OWNER MAILING ADDRESS:
- !
OWNER PROPERTY ADDRESS: _ Aie-cJ
TELEPHONE NUMBER OF CONTACT. PERSON: 2-FY" X675`
TAX MAP NO. : Section l 3 Block
•
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE
441911F
•
• �� Sigr g tur of pplicant
•
RECEIVED BY:
Town Cleric's Office
DATE: •
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LOCATION R AAr.• �=='L�'v.lis e Scale: .
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