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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® •
rri P.O. Box 1179
tin Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = �✓® �� Fax (516) 765-1823
MARRIAGE OFFICER Telephone` ® �� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1074 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ENVIRONMENTS EAST, INC.
Address 1 : P. O. BOX 190
City St Zip PECONIC NY 11958
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. #92-SO-107.
Name Of Owner HAMMER, ROBERT AND MARY
Mailing Address 1 35 NORMANDY LANE
City St Zip MANHASSET NY 11030
Property Address 1 1000 OLD MENHADEN LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 111 .00 block 4 lot 17.000
Cross Street HAYWATERS ROAD
Building Permit Number Cross Reference:
Issue Date: 12/10/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK rrn P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER O ®�
Fax (516) 765-1823
---__ ift ��llr �� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO; Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 8, 1993
Transmitted herewith is a copy of application No. 1108 for a Cesspool/
Septic Tank Construction Permit submitted by:
Environment East, Inc. for Robert & Mary Hammer
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.
�c.cew
Linda J. Cooper
* * * * * * * * * * * *
I
have reviewed the application and location map of the project cited above
and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: of - • 47" 9 2- 56—ye 7
",
Signature
Dated
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OFFICE OF THE TOWN CLERK `��� --->',c-
Town
•
Town of Southold Q�`'r`� i' .'
Judith T. Terry, Town Cleric C' �'''r ` .~ ! (/
�� f Application No! �J
Town Hall, 53095 Main Road ~ �� �
P. O. Box 1179 , "��" v�
�' i'�`• Fft,lh; Construction
Southold, New York 119710�' �' r.j
Q�- Alteration
Telephone °l �- ' t�
(516) 765- 1301 Residential
irl�
Non-Residential
TOWN OF SOUTHOLD
• SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
•
•
APPLICATION
for
•
CONSTRUCTION or ALTERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 141 lal.3
. APPLICANT NAME: i G
APPLICANT ADDRESS: r®2JO 1 t 90
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: (n ,,
OWNER MAILING ADDRESS.
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OWNER PROPERTY ADDRESS: We)
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TELEPHONE NUMBER OF
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CONTACT PERSON: _ -161-10- (-(-7
TAX MAP NO. : Section [ Al • Block Lo
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CROSS STREET: ti, I� —S i�-„ .
BUILDING PERMIT NUMBER CROSS REFEREN
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RECEIVED BY:
Town Clerk's Office
DATE: •
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