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JUDITH T.TERRY eg Town Hall,53095 Main Road
TOWN CLERK �i g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS 0 1� Southold,New York 11971
MARRIAGE OFFICER =�0 ®Q IIS Fax(516)765-1823
RECORDS MANAGEMENT OFFICER ®� .1\ I Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER ��,,, ,/•8°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1204 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW CESSPOOL 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 MACDONALD, KEVIN
Mailing Address 1 185 HOLDEN AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 185 HOLDEN AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 2 lot 12.000
Cross Street WEST ROAD
Building Permit Number Cross Reference:
Issue Date: 9/15/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : f .4. t.
Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
VI Southold, New York 11971
REGISTRAR OF VITAL STATISTICS :,�® ,��' Fax (516) 765-1823
MARRIAGE OFFICER = �1
RECORDS MANAGEMENT OFFICER ,.. i lig Telephone (516) 765 1801
FREEDOM OF INFORMATION OFFICER = -- �.,,rr!���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: September 8, 1994
Transmitted herewith is a copy of application No. A1249 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Kevin MacDonald
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:
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APPROVE -
DISAPPROVE - �•�►,� _a ; 6_ ;,I
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Signatur=
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-"OFFh'CE OF THE TOWN CLERK �,.,,""""%,,
Town of Southold ��.�'1 41f U'ke
Judith T. Terry, Town Clerk �� �% .< ®Gy: Application No./ 99
Town Hall, 53095 Main Road ;�O "'• Construction
P. 0. -Box 1179 _ - <: _ '
Alteration
Southold, New York 11971 c,. '�.. �•
Telephone ;y0 Q'0 $10.00 - Residential (/
(516) 765-1801 .
- 1 ' $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
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APPLICANT NAME: "-Z/7 a/YyZre
APPLICANT ADDRESS: 27� 6 /�/�P.„��, �r(
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SEPTIC CESSPOOL
DESCRIPTION OF P •POSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: . Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION
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. OWNER OF PROPERTY: 1 Pse `�- 4�
OWNER MAILING ADDRESS: /rfr /76- '%U-
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OWNER PROPERTY ADDRESS: '
TELEPHONE NUMBER OF CONTACT PERSON: {�f?GcfL�� /` / Z---
TAX MAP NO. : Section//O Block 2_ Lot /F----
CROSS
ZCROSS STREET v <...Q
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BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Applicant
RECEIVED BY: > iii--&-t-i-wt-e_.- .
own Clerk's Office
DATE: �i� .
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