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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK : ® ' P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� Fax (516) 765-1823
MARRIAGE OFFICER 41 Jti. Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER -_W1 IIT.
FREEDOM OF INFORMATION OFFICER =�� �ii1°.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1077 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
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 DISTANCES FROM ADJACENT
WELLS, BUILDINGS ANDN PROPERTY LINES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner MARSICH
Mailing Address 1 72-36 112TH STREET
City St Zip FOREST HILLS NY 11375
Property Address 1 260 PARSONS BLVD.
City St Zip EAST MARION NY 11939
Tax Map No. section 37.00 block 1 lot 14.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 12/23/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY 0 Town Hall, 53095 Main Road
TOWN CLERK z ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
�' r' Fax 516 765-1823
MARRIAGE OFFICER r ( )
,�® •�� ���" Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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TO: Southold Town Building Department a i;`"a—..b-2 s ._ '
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' FROM: Linda Cooper, Southold Town Clerk's Office ! DEC 6 41114
10
DATED: December 14, 1993 ��
• L TOWN OF SOa�7;,;tst_' -
Transmitted herewith is a copy of application No. A1112 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Marsich .
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
* * * * * * * * * * * * *
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I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - d/ 1YM fI SPECT F
DISAPPROVE - OCR_5)
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COMMENTS: i, ; ', 'r
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Tem! cloa SAutflda Date
OFFICE OF THE TOWN CLERK ,,,,'",,,""--.,
Town of Southold .�'" 00FMX
Town Clerk �'. % ` �(4,d,--- Application No.fil-//�
Judith T. Terry, � �, ,�-
Town Hall, 53095 Main Road ���{ Construction
P. O. Box 1179 " z i
Alteration
Southold, New York 11971 frl - 1. 4',:
Telephone `_ , • _�'®��*' $10.00 - Residential V
(516) 765-1801' _ ('.L 4' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
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Permit No.
Fee $
DATE // , / / /5322
APPLICANT NAME: i?7,4er.S ' bi / /c,,e, J,
APPLICANT ADDRESS: 7 7 .61 /cdt i' cQt%
cSocr rder /1717',27
SEPTIC CESSPOOL("
DESCRIPTION OF- PROPOSED CONSTRUCT ON OR ALTERATION
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LOCATION MAP: Must be attached hereto beforepermit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: RS ) d
OWNER OF PROPERTY: / d,r,'/ (44444C-12(
OWNER MAILING ADDRESS: 701.— 36. /!a
>e, r ;- -1 : 'r 4 " L--6ea - -(46;-6,
OWNER PROPERTY ADDRESS: o?(,, c) )00_/,,_4....0„, —d jri3 73
TELEPHONE NUMBER OF CONTACT PERSON: 7/1 _5.fcro
TAX MAP NO. : Section 3 7 Block / Lot ) y
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
elk
4/0 )V 7/ZiK7 -
gnature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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