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JUDITH T. TERRY ' _ Town Hall, 53095 Main Road
TOWN CLERK O T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �` Southold, New York 11971
� Fax (516) 765-1823
MARRIAGE OFFICER
*62 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. 984 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RAYMOND NINE
Address 1 : P. O. BOX 1401
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or. Alteration
INSTALL TWO NEW CESSPOOLS.
APPROVED AS SUBMITTED. DISPOSE OF EXISTING POOLS. EXCAVATION
INSPECTION REQUIRED. CALL 765-1802 FOR APPOINTMENT.
Name Of Owner SCHOLL, FRANKLIN
Mailing Address 1 1340 BUNGALOW LANE
City St Zip MATTITUCK NY 11952
Property Address 1 1340 BUNGALOW LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 2 lot 17.002
Cross Street PARK AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/23/93 Judith T. Terry
Southold Town Clerk
iTOWN SFAI
t'Yi
JUDITH T. TERRY !. Town Hall, 53095 Main Road
TOWN CLERK tp P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS N` Southold, New York 11971
MARRIAGE OFFICER ,V �0� Fax (516) 765-1823
®tii® S?S�' ��®�61� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK fr'zi.; -7,:—` _,- "7 ,",,
TOWN OF SOUTHOLD t! t i,' ----23 - 1_5 ; f
TO: Southold Town Building Department k•'1 APR 3199 •
FROM: Linda Cooper, Southold Town Clerk's Office „' `��-_- --•�- - - -_ ' --
DATED: April 23, 1993 •T0' `aJ`u' � ��
Transmitted herewith is a copy of application No. A1012 for an •
ALTERATION PERMIT for a cesspool or septic system submitted by
Raymond Nine for Franklin Scholl
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.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - J�
DISAPPROVE -
COMMENTS: ( . pp (�� (�(1.,,, -.,^ n� �-�- ch �e e� `k"/ ,
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Date
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OFFICE OF THE TOWN CLERK �,'",,,,"'''-
Town of Southold .'' �tf alr � /OP--
41.1-
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�� ' Application No. /
Judith T. Terry, Town Clerk �Os ��
Town Hall, 53095 Main Road �� �O =' L - Construction
P. O. Box 1179
Southold, New York 11971 n' Alteration
Tele hone ,� •
Oi�� $10.00 - Residential
(516) 765-1801 = ®1 � '�s $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE I// 23 43
APPLICANT NAME: if iy
APPLICANT ADDRESS:
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/r s7-/911 7`410 cESf(' oc..
LOCATION MAP: Must be attached hereto before permit may be issued. •
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: N-4 2_1 iv H
OWNER
C •
-
OWNER MAILING ADDRESS: /300- ERA, ji-1/ G G,/ 4-1A 1L'
OWNER PROPERTY ADDRESS: S f;CZE. -
TELEPHONE NUMBER OF CONTACT PERSON: d?cf froze"
TAX MAP NO. : Section /2_3 Block 2 Lot
CROSS STREET: ® )91/
BUILDING PERMIT NUMBER CROSS REFERENCE: 2.1 2-f L!•
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4plicant
S :nature of
RECEIVED BY:
Town C erk's Office
•
DATE:
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