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JUDITH T.TERRY �� * 1 Town Hall, 53095 Main Road
TOWN CLERK y Z P.O. Box 1179
v ,� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
?, Fax Fax(516) 765-1823
MARRIAGE OFFICER .** °-0 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 1 J�R ��
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. 1413 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JAMES AND KATHLEEN HYGOM
Address 1 : 905 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
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.
Name Of Owner HYGOM, JAMES AND KATHLEEN
Mailing Address 1 905 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 HALL'S CREEK DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.028
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 11/14/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/ Y/3
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JUDITH T.TERRY ' > t = Town Hall,53095 Main Road
TOWN CLERK '
� _ti �, � � P.O.Box 1179
�® $ Southold,New York 11971
REGISTRAR OF VITAL STATISTICS N 4' 0 N �1 Fax(516)765-1823
MARRIAGE OFFICER '�® : �� Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER .1 EDf.�
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 L 6, 1995
Transmitted herewith is a copy of application No. 1466 for a Cesspool/
Septic Tank Construction Permit submitted by:
James S. & Kathleen Hyqom •
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. l � Yfl \,1l ��^r
a NOV 61995
TOWNLUQ' C L nda J. Cooper
OF SCiri 01
* * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE !/
DISAPPROVE
Comments: /gage/2r/
ssio
, ,ig G"- i Aer,1.
Signatur-
/7/9979
Dated
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OFFICE OF THE TOWN CLERK ,.,'""""' •
.�
Town of Southold '.� UF�U�K _
Judith T. Terry, Town Clerk ��'� �� - ��l/ Application No./±1.
� O,< -Ry
Town Hall, 53095 Main Road Z ,, : Construction 17
P. 0. Box 1179 , = y-;, mm ,
Southold, New York 11971 ,cn • ``, ,��. � Alteration
Telephone ..0 e I •C'i $10.00 - Residential I
(516) 765-1801 = 01 �, ' $25.00 -Non-Residential
• -- , , I,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
REL 'ION
Nov6 •
CONSTRUCTION or ALTERATION PERMIT
Southold Town Clens
SEPTIC TANK or CESSPOOL
Permit No.
Fee- $
•
DATE NO U l qa ,
APPLICANT NAME: JG , 'e_ \&c.&(\\.-cr_v,..) ‘--\.LIgsw-N.
APPLICANT ADDRESS: 905- R�c�,�. \N PSV(u _
�-��c�c� �. \K). . 1\a0S
SEPTIC ✓ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
"( -C.)..3 C.,0\ -\\CU..(___ 0 C.c . `N- - Ikt. . lift.- 3 _
LOCATION MAP: ' Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Acj, \- Z \_ �\N\ ,3 \V c }
OWNER MAILING ADDRESS: o.5 RC.��01/46r\ ' Ue�
OWNER PROPERTY ADDRESS: \-\c\\'s �C� k ���V-�
TELEPHONE NUMBER OF CONTACT PERSON: 73(4 71 ao
TAX MAP NO. : Section MNTBlock l(7 Lot t. 2 8
CROSS STREET: \\)e... 5<>,c—V-T L SL) e
,
BUILDING PERMIT NUMBER CROSS RE ERENCE:
!
AA Ali iA iii
/ Signature off plicant
RECEIVED BY: , 5a-
own lerk's Office
DATE: Ij ' (, ' yr✓ .
0 ld
A 'Jr.en�_ 'z s. Young,
O
- - _ 88
ZS t _
�-, --- - _ Howard- oath
Thomas C.-:Wolpert,:`fpr•
- Kenneth F. A br uz�o
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Lot 33
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