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JUDITH T.TERRY ;, Town Hall,53095 Main Road
TOWN CLERK ero "' P.O.Box 1179
6 ;xrab:. % Southold,New York 11971
REGISTRAR
RMARRIIAF E OFF ER VITAL STATISTICS
�`4� C) / Fax(516)7654823
RECORDS MANAGEMENT OFFICER ®1 ED .1° Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER sa,"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
• SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1393 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JACOB PAUL SCHEINER
Address 1 : 275 WOODEND WAY
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF A NEW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner SCHEINER, JACOB PAUL
Mailing Address 1 P. O. BOX 1285
City St Zip SOUTHOLD NY 11971
Property Address 1 275 WOODEND WAY
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 11 lot 18.000
Cross Street BEACHWOOD
Building Permit Number Cross Reference:
Issue Date: 9/18/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
J ''74
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JUDITH T.TERRY ` ® �� % Town Hall,53095 Main Road
TOWN CLERK k c t P.O.Box 1179
REGISTRAR OF VITAL STATISTICS .`� O t' �� Southold,New York 11971
MARRIAGE OFFICER .#..^ • i Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : X11 ED V„, Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,,06
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: September 18, 1995
Transmitted herewith is a copy of application No. A1446 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
- Jacob Paul Scheiner (by Ray Nine) .
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
r
44-1.6r-4-,
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
hII'7EiA I I I I I°P, e 1,
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1 Signature i
L! /r4Date
BLDG.DEPT.
TOWN OF SOUTHOLD ;I
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OFFICE -OF THE TOWN CLERK .,'""
Town of Southold soiac fake,.
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• Judith T. Terry, Town Clerk Application No. /z/4/Town Hall, 53095 Main Road ;� Construction
P. O. Box 1179 � o FA
Southold, New York 11971 , t�t2 • yc Alteration
Telephone =0 AN"/� $10.00,- Residential
(516) 765-1801 --__ 1 0
'� $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLDWASTEWATER DISPOSAL DISTRICT
APPLICATION -
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
•
DATE //8/7.5----
APPLICANT NAME: ,ScL,,�:vLe2 St toI r4k
APPLICANT ADDRESS: ,.75-- („J0001e4d 1,44v-
cowfto/d /4 // 7/
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: -Set co1 PAS 1 cc_Lt_•ner—
OWNER MAILING ADDRESS: Pb jtry. 2eC
Sa f�,o
le
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7( 5 -2YVS/Q
TAX MAP NO. : Section —20 Block l7 Lot /C�
CROSS STREET: 6, c40foo �✓
BUILDING PERMIT NUMBER CROSS REFERENCE:
LAJJ
Signature of Applicant
RECEIVED BY:
Town CleRMettke
DATE: SEP 1 8 1995
[own Clerk South'otd
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