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OFFICE OF THE TOWN CLERK c0FUCKe,-
Town of Southold ol/
Judith T. Terry, Town Clerk .` °� y 1
Town Hall, 53095 Main Road I uVT-,; "2=
P.
P. O. Box 1179 .� ' ' a ` t-6 •
Southold,
Southold, New York 11971 Off; •
0 ��,
Telephone Ol
* % ,/
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 12 Residential XXX
Fee $ Non-Residential
10 , 00
SepticXxX Cesspool
PERMIT ISSUED TO:
NAME: William S . Meyran
ADDRESS:. 20 Sintsink Drive West
Port Washington. N.Y. 11050
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
-
new system. for ,new one family dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: William S . Jvieyran
OWNER MAILING ADDRESS: 20 Sintsink Drive West
Port Washington, N.Y. 11050
' - OWNERPROPERTYADDRESS : Saltaire Way
Mattituck, New York
TAX MAP NO. : Section 100 Block 0100 Lot 20
CROSS STREET: Wavecrest Lane
BUILDING PERMIT NUMBER CROSS REFERENCE:
Judit . er
Southold Town Cler"
DATE : August 15 , 1986
(TOWN SEAL)
t
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk Application No.
//
Town Hall, 53095 Main Road Construction 1.7"--
P.
VP. 0. Box 1179
Southold, New York 11971 Alteration
Telephone Residential ✓
(516) 765-1801 Non-Residential
;,•, :, TOWN OF SOUTHOLD
P ; 0`c 1986 SOUTHOLD WASTEWATER DISPOSAL DISTRICT
fnwn C+•^i.: �;hC
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /b "
DATE Ae, 2 / 9 � G
APPLICANT NAME: a..//7//,,,.t,
APPLICANT ADDRESS: � Ste'<Z � Sia /t �. -es � CS�-�'�� '�`e
4, GU. //v 3-6) (11'7cf f7'r' c
SEPTIC —eESSPOOL1----
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
eiz, Ti SLj 51 74-e.-i? e_L:..1%KiP'•�,L�G� 7;>..ec5 l7c-Sc.� '�r vr� ,,*-epi-r,'EfP}C� J.3'°
LOCATION MAP: Must be attached hereto before permit may'be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: � ,.//;ay„ Jr kr,"4.,,,
OWNER MAILING ADDRESS: 0 1/07_7,- 'es 74-
AO ', �- GtJ s�_ , 47, /lc, S -v
OWNER PROPERTY ADDRESS: 3e4/74cd_,'0-r Gvo
fic- ('-/4c/c.
00/4 )
TELEPHONE NUMBER OF CONTACT PERSON: g83 S/� ,5 i'/ '`/3o4)
TAX MAP NO. : Section /off Block (7/, c-> Lot 2
•
CROSS STREET:- (mac„,„ L BUILDING PERMIT PERMIT NUMBER CROSS REFERENCE: /3..:m:t1. ,-
Sign ire of pplicant
RECEIVED BY: a, �c ���
Town C�rk's Office
DATE: 7 /Sfj�
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_t ,; • SUFFOLK CO HEALTH DEFT APPROVAL—I
3- N S NC),
SUFFOLK COUNTY
DEPT. OF HEALTH
RIVERHE{•.�L N.Y. 11901
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- riAr 7 II 43 Aid F86
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_,.___.._._.__.___._...._.____�. ___. _ _._._...__.._-._-_... STATEMENT OF INTENT
4 1•.)[: 0- - t-i1<w. THE WATER SUPPLY AND SEWAGE DISPOSAL
I �� , '\ f ") i� SYSTEMS FOR THIS RESIDENCE WILL
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CONSTRUCTION ONLY5—
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