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OFFICE OF THE TOWN CLERK S\\FFULA-
Town of Southold % �G
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 O ., O�•�,
Telephone y --WO/ t '
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 63 Residential X
Non-Residential
Fee $ 10.00
Septic X Cesspool X
PERMIT ISSUED TO:
NAME: Robert C. Reeves, Jr.
ADDRESS: P.O. Box 215, Oysterpond Lane
Orient, New York 11957
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION •
New dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER O-F PROPERTY: Robert C. Reeves, Jr.
OWNER MAILING ADDRESS: P.O. Box 215
Orient, . New York 11957
OWNER PROPERTY ADDRESS: Navy Street
Orient, New York
TAX MAP NO. : Section 25 Block 4 Lot 4
CROSS STREET: Orchard Street
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
aore,404;:e9407.".000,.....•
Judith T. Terr
Southold Town Clerk
DATE : October 29, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk Application No. ��
Town Hail, 53095 Main Road Construction z�
P. O. Box 1179 Alteration
Southold, New York 11971
Telephone • 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. 63
Fee •$ /C
DATE
fQ/ -77f •
APPLICANT NAME: r. ®‘
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APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF ,PROPOSED CONSTRUCTION OR ALTERATION ,./t263 l�
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CO UC ION OR ALTER ION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: f9 `�'so ;5 3
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OWNER PROPERTY ADDRESS:,\
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TELEPHONE NUMBER OF CONTACT PERSON: //6 3 2_ 5 • ,7 (0 /3
TAX MAP NO. : Section 697 'Block ci Lot
CROSS STREET: O RJ, q . SZ,
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of App ant
RECEIVED
Town lClerk's ffIce�w
DATE: �Icc� J c 9, /C,Z •
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1 ; , , ' SUFFOLK CO. HEALTH DEPT. APPROVAL
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SNL FAMILY DWELLING ONLY
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; STATEMENT OF INTENT
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SYSTEMS FOR THIS RESIDENCE WILL.
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SUFFOLK COUNTY DEPT. OF HEALTH
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CONSTRUCTION ONLY
DATE:
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LICENSED LAND SURyEYORS ...s1 4 S 25161'bio`d'
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GREENPORT NEW'YORK ,,,,
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; l[DYNE POST N61239 ; , ,
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