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71
JUDITH T. TERRY /,' - _T. " ���
u� Town Hall, 53095 Main Road
g783T-4 P.O. Box 1179
REGISTRAR OTOWN TAELSTATISTICS a, �' Southold, New York 11971
MARRIAGE OFFICER �' r Fax (516) 765-1823
®������! Fax
(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. 777 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RAYMOND NINE
Address 1 : 298-8828
City St Zip 00000
Descripton of Proposed Construction or Alteration
INSTALL 8' X 8' POOL IN SAME LOCATION TO REPLACE COLLAPSED POOL.
APPROVED AS SUBMITTED. REMOVE ALL EXISTING MATERIAL (POOL
CONSTRUCTION. EXCAVATION INSPECTION REQUIRED. CALL SOUTHOLD TOWN
BUILDING DEPARTMENT (765-1802) FOR AN INSPECTION.
Name Of Owner MANERI, MADELINE
Mailing Address 1 2200 PIKE STREET
City St Zip MATTITUCK NY 11952
Property Address 1 2200 PIKE STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 3 lot 23.000
Cross Street MARY'S ROAD
Building Permit Number Cross Reference:
Issue Date: 11/19/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
je-
��' r� 4- a :;�' -ft.. Town Hall, 53095 Main Road
=•4-T�KITH T. TERRY ��� ��� � � ,
"" TOWN CLERK k = e t , ` P.O. Box 1179
—"':.ISTRAR OF VITAL STATISTICS C75 *V. { Southold, New York 11971
' MARRIAGE OFFICER ":' ���� Fax (516) 765-1823
MARRIAGE
����! Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERKF` Aw +
TOWN OF SOUTHOLD lig 84 n
November 14, 1991 }_ S
BLDG DEPT.
TOWN OF SOUTHOLD'``''J''=
To: Southold Town Code Enforcement "Officer , .
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A 797 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Raymond Nine for Madeline Maneri .
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.
(9 'u...,
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - X
DISAPPROVE -
COMMENTS: yo jiatuut.. C,, q, S f'649 •
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RECEIVED
{:5—LI. C ..Z.?oz..*041_
NOV I ) 1991 Signature
TOM Clerk Scutt ori' 1 ///1/7 1
Date
OFFICE OF THE TOWN CLERK �,,,,'",,,,"",%
Town of Southold �'' � f 110( '� =
�J Application No. c-7I71/
Judith T. Terry, Town Clerk Gy
Town Hall, 53095 Main Road Z < Cons ruction .6-7,-
P. O. Box 1179 rn
Southold, New York 11971, tt� 4/ Alte -tion
Telephone .. ���' $10.00 - Resi'dehtial;
(516) 765-1801 = �l ° $25.00, - Non-Residential
• -- .1.1#0 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. M
Fee $
DATE 141j lye/
APPLICANT NAME: ni sn/'
APPLICANT ADDRESS: 22eaE.:7-
h) A2-77 17 11G' N-/ 1 4;?--
SEPTIC
--
SEPTIC CESSPOOL IV
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION - ,
eV' tiL-E1( FLt )
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: -
TELEPHONE NUMBER OF CONTACT PERSON: IPA ri 0/4 A i NcP oce
J
TAX MAP NO. : Section / ?/ I
61 Block Lot c23
CROSS STREET: PI )96 yf' g0,9
BUILDING PERMIT NUMBER CROSS REFERENCE:
- f re of Applicant
RECEIVED BY: �Q
Town C_erk's Office
•
DATE: f` iN
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