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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK zP.O. Box 1179
REGISTRAR OF VITAL STATISTICS Z.
Southold, New York 11971
MARRIAGE OFFICER �® � Fax (516) 765-1823
—I �® '' 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. 759 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : HELEN MACNISH
Address 1 : P. O. BOX 492
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
REPLACEMENT OF AN EXISTING CESSPOOL.
APPROVED AS SUBMITTED. HOLD DISTANCE FROM WELL TO EXISTING WITH NEW
POOL. EXCAVATION INSPECTION REQUIRED. CALL 765-1802 FOR AN
APPOINTMENT.
Name Of Owner MACNISH, HELEN
Mailing Address 1 P. O. BOX 492
City St Zip SOUTHOLD NY 11971
Property Address 1 2750 PINE NECK ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 10 lot 3.000
Cross Street OAKLAWN AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/24/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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SEP 9 91991
s ,j11 Town Hall, 53095 Main Road
P.O. Box 1179
1313Ay
DEPS � ' � , iii Southold, New York 11971
JUDITH T. yi921%N. Oar SHO„t” TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
' TOWN OF SOUTHOLD
September 19, 1991
To: Southold Town Code Entorcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. /q 78.2 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Helen MacNish
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 followingrecommendation:
APPROVE - Dy
DISAPPROVE - nn ___-p__ p nn
COMMENTS: o,.® _ ,w„ci.�uxst.ct 0-•1 clitak
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,.b-Q a1/4 .c.�
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Signature
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Date
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,:.� ,f"` k Town Hall, 53095 Main Road
= :, -i ':',..1 ki P.O. Box 1179
.y/ . -;; cy Southold, New York 11971
ir,
JUDITH T. TERRY =. TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK _
TOWN OF SOUTHOLD
September 19, 1991
To: Southold Town Code Entorcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. 782 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Helen MacNish .
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>)-1i,t-rf_c,c
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following, recommendation:
APPROVE -
DISAPPROVE -
COMMENTS:
•
Signature
Date
OFFICE OF THE TOWN CLERK ,,,'",,,"
Town of Southold _
Town Clerk %� �Ol Application No.
Judith T. Terry, y
Town Hall, 53095 Main Road ; F... Construction
P. O. Box 1179 ; c rnz
Southold, New York 11971 �tt� �, AlterationkV:-
V
Telephone -�0,jj,�, .lip0"/ $10.00 - Residential
(516) 765-1801 = �1 , �' $25.00 - Non-Residential
040V49040V49#14. _I'
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT.
SEPTIC TANK or CESSPOOL
ti
Permit No.
Fee $
DATE 7 -
APPLICANT NAME: !'j,, �, e
APPLICANT ADDRESS: r: 0, C )( di 9 ' \ \i , , I (q) 1
7 O (pQ-- ().ems .�
SEPTIC CESSPOOL %C
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
V
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:�
OWNER OF PROPERTY: Vr cce_ ��0
OWNER MAILING ADDRESS: (PcQc C)(2
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 7O Block /0 Lot 3
CROSS STREET: G
BUILDING PERMIT NUMBER CROSS REFERENCE:
Ojigge44.,\Yn ok,e) \K)' jag
Signature of Applicant
RECEIVED BY:.
-Weft Clerk's Office
DATE: ^ Sip 1 1991
Town Clerk Sbatfordf
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