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1Town Hall, 53095 Main Road
„, P.O. Box 1179
`°N1Q°• Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516)765-1801
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. 363 R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
PERMIT ISSUED TO:
Name : A. REILLY & SONS INC.
Address 1: BOX 434
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED.
Name Of Owner SAYWELL, CLIFFORD & MURIEL
Mailing Address 1
City St Zip 0000
Property Address 1 NORTH BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 2 lot 3 . 001
Cross Street SHIPS DRIVE
Building Permit Number Cross Reference:
Issue Date: 6/24/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OFFICE OF THE TOWN CLERK S �Fja
Town of Southold 0�� C�
Application No. 36.7
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road tin , e' Construction
•P. O. Box 1179 ,�. �
® �-_� �� Alteration
Southold, New York 11971 .,.
Telephone of �I% 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. (e ,'
Fee $ /
DATE G 23 / r
APPLICANT NAME: •,e/AV .c14-12b /(./,f /,V c
APPLICANT ADDRESS: )( V31/ ,,e7 /P.-r'-}-/7" c/i C /(/(V
SEPTIC 1. --CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/ ecAs7 Se77 /. X/2
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C. 5 4y/,t/eG,z
OWNER MAILING ADDRESS: 5007 /lot- D N .
OWNER PROPERTY ADDRESS: it/ 6/10 ( EC) f 7
S o c-1 G-1 0 f di1 /U- ? -7 /
TELEPHONE NUMBER OF CONTACT PERSON: ZF r
TAX MAP NO. : Section Block 2- Lot 7 (
CROSS STREET: ____
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
P2-Q-7\
Signature of Applicant
RECEIVED BY :
Town Clerk's Office
DATE:
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SR cowry DEPARTMENT OF IALTH SERVICES
Ja Q. FOR APPROVAL OF CONSTRUCTION OF
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APPROVED _
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