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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERKa P.O. Box 1179
} :.rrT1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �r Fax (516) 765-1823
®� ®��i�� 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. 667 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : KATHERYN RAYNIS
Address 1 : SMITH ROAD
City St Zip PECONIC NY 11958
Descripton of Proposed Construction or Alteration
NEW CESSPOOL TO HANDLE WASTEWATER FROM WASHING MACHINE IN ACCESSORY
BUILDING.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED BEFORE COVERING
THE POOL. CALL 765-1802 FOR AN APPOINTMENT.
Name Of Owner RAYNIS, KATHERYN
Mailing Address 1 SMITH ROAD
City St Zip PECONIC NY 11958
Property Address 1 SMITH ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 98.00 block 3 lot 2.000
Cross Street INDIAN NECK LANE
Building Permit Number Cross Reference:
Issue Date: 12/06/90 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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°F •w, `�' Town Hall, 53095 Main Road
BLDG.DEPT. *,�'' :"� ��' ��` P.O. Box 1179
TOWN OF SOUTHOLD ®`� ,, '- . 5.-��.
_'_®1 it �L.ry'%'� ��0� Southold, New York 11971
JUDITH T.TERRY ---......,,,,,s0 TELEPHONE
TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK •
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: December 4, 1990
Transmitted herewith is a copy of application No. 683 for a Cesspool/
Septic Tank Construction Permit submitted by:
Charlie Taplin for Katheryn Raynis - .
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
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OFFICE`OF THE TOWN CLERK ,,,'"',,,"
Town of Southold .01 c.,�V Wire;� = Application No. ��
Judith T. Terry, Town Clerk ��� Gy
Town Hall, 53095 Main Road � �= Construction
P. O. Box 1179 ti
Southold, New York 11971 a/ Alteration
Tele hone tea - Q� '� $10.00 -Residential c�
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(516) 765-1801 -_ �, 0' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPL!CAT!ON
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$ /O
DATE f e-ei O
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APPLICANT NAME: �cv 4 /-�,y APL, j
APPLICANT ADDRESS: S'ri1.<1( /0
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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: /��,�(P, ,� kQl,_fri1
OWNER MAILING ADDRESS: _fm/71(,744 /P -
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OWNER PROPERTY ADDRESS: 17 co p
TELEPHONE NUMBER OF CONTACT -PERSON:
TAX MAP NO. : Section 7d Block 7 Lot W-4
CROSS STREET: /fyecA Gc�ye-
BUILDING PERMIT NUMBER CROSS REFERENCE: f94"77
Signature of Applicant
RECEIVED BY:
Town Clerk's Office -
DATE:
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SUFFOLK COUNTY, N. Y.
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I ,� 1.•• , ' N.Y.S._ LIC. NO. 49618
I PE •N r".1 RVEYORS, P.C. . i
20
AREA = I ... 1; (51.17_ - 50
P. O. =OX 909
20, 127 sq. f t. MAIN ROAD` .
SOUTHOLD, N.Y. 11971 ,
- 90 - 258