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'$ Town Hall, 53095 Main Road
���, P.O. Box 1179
�,.. Southold, New York 11971
JUDITH T.TERRY ---, � �''
� � o•oTELEPHONE)765-1823 765 1
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 639 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : J. P. DUNNE
Address 1 : PINE NECK ROAD
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 8/24/90.
Name Of Owner RAST, GAIL
Mailing Address 1 NEW SUFFOLK AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 TUTHILL ROAD EXT.
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 6 lot 15.001
Cross Street ORIOLE DRIVE
Building Permit Number Cross Reference:
Issue Date: 9/10/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
Ys
Receivr* /,f4
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�, ,� 9 O � - M ffr Town Hall, 53095 Main Road� `�� P.O. Box 1179
p�°p3BO'� �� �, �o� Southold, New York 11971
JUDf" T:T�R �T' .":" 4,00010141- TELEPHONE
TOWN CLERK
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REGISTRAR OF VITAL STATISTICS i
OFFICE OF THE TOWN CLERKi----�_- 11
I:
TOWN OF SOUTHOLDht( � `a
AUG 2 9 1990 I
To: Southold Town Code Enforcement Officer
l
BLDG. DEPT.
From: Linda Cooper, Southold Town Clerk's Office TOWN OFoUTH®LD
Dated: August 29, 1990
Transmitted herewith is a copy of application No. 654 for a Cesspool/
Septic Tank Construction Permit submitted by:
J. P. Dunne for Gail Rast
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
DISAPPROVE
Comments: �, - �.0 e C SAL u•,, Com , a e t.�.1l
(1)4-1 r-A-1,-)&4 V
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Signature
ck\Lk\Q(
Dated
1. i--
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OFFICE OF THE TOWN CLERK c FiL _
JudithTown of T. Terry, Toold e wn Clerk r, -> 0� • pp i �K
�r y Application No.6
Town Hall, 53095 Main Road Construction C�
P. O. Box 1179 u-i , . =,'""'`.
`G'' 'r - '" Alteration
Southold, New York 11971 ,y, ��-$,
Telephone 01 s [ ' t• Residential
.(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. -
Fee $
DATE — 5 `)
APPLICANT NAME: Z., 2' OBJ
APPLICANT ADDRESS: k r-e
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SEPTIC CESSPOOL ---------
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/t-e_C-,l x „..ter,, (t.c,(.,LPII4 y- 4,1 etuLrte-- L,--",-
•
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR-ALTERATION:
OWNER OF PROPERTY: �a I G-- l c rc—
OWNER MAILING ADDRESS: //kW Sti pF 1, 6 /4/-t
C /4 Te41 6" pi c ) 41/.
OWNER PROPERTY ADDRESS: rt4 7-17 /7-1 EX '
Co k ro‘ l-r--1 /11-y -
TELEPHONE NUMBER OF CONTACT PERSON: 5-74‘-- G s----S-95 D
TAX MAP NO. : Section , SBlock , Lot / 3 4,
CROSS STREET: 6 g ) ® h C'J
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
illkik oi_ ' 62 Z).4----vt.--vt-k____ '
i.nature of Applicant ,
RECEIVED BY:
Town lerk's Office
DATE: , Sic)-?1
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