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• CAlif Writ JUDITH T. TERRY % & ' Town Hall, 53095 Main Road ; P.O. Box 1179 TON CLERK ale • REGISTRAR OF VITAL STATISTICS rri ; Southold, New York 11971 MARRIAGE OFFICER : Fax (516) 765-1823 fee� / Telephone (516) 765-1801 1 0° OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 671 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : MOHRING ENTERPRISES Address 1 : 323 GLEN COVE AVENUE City St Zip SEA CLIFF NY 11579 Descripton of Proposed Construction or Alteration NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ON 11/29/90. Name Of Owner MOHRING ENTERPRISES Mailing Address 1 323 GLEN COVE AVENUE City St. Zip SEA CLIFF NY 11579 Property Address 1 LAUREL AVENUE City St Zip SOUTHOLD NY 11971 Tax Map No. section 56.00 block 1 lot 2.000 Cross Street POND AVENUE Building Permit Number Cross Reference: Issue Date: 1/14/91 Judith T. Terry Southold Town Clerk (TOWN SEAL) • ''''WeTrOV[V fi 2 @ ,. cA f[lure- TOWN OF ,,t414/ `+ r� ti Town Hall, 53095 Main Road ` x ` 4i P.O. P.O. Box 1179 �® to Southold, New York 11971 JUDITH T.TERRY ����� i���� TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Southold Town Code Enforcement Officer From: Linda Cooper, Southold Town Clerk's Office Dated: December 26, 1990 Transmitted herewith is a copy of application No. 6e for a Cesspool/ Septic Tank Construction Permit submitted by: Mohring Enterprises, Inc. Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Thank you. • Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: c'.- Q h (\�it,, clnksue)l °�- ouske.4...ko, %t.k.1)5,ze kl,s1.1,3L IN> ,°‘\,e\o Signature IL13\\civ Dated iL j OFFICE OF THE TOWN CLERK �,0, ( �y Town of Southold •'�4 cj�F�ULk'0 = Application No. 6 0 / Judith T. Terry, Town Clerk ��� **2-:'% � Town Hall, 53095 Main Road Construction / P: O. Box 1179 . = mc Southold, New York 11971 a '4.'1 Alteration / Telephone _0,��,• ®�,' $10.00 - Residential t� (516) 765-1801 7..___ Ol $25.00 -Non-Residential • -- ,,,,ail TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee •$ DATE a/ C.// 7C)\ APPLICANT NAME: /4c I-7071-0C E.kt 4 APPLICANT ADDRESS: D3 �'(� (tel Co Cp ,c. 4c., c f ~ JCrCz c C lit.. r"\ , // 2,2 SEPTIC ) CESSPOOL ( LO ti C- P6 N (7 &S-7-S_ ) DESCRIPTION OF PROPOSED CONS(-0-(3-7----C RUCTION OR ALTERATION N G- L-. . I '17sD- `V V -C .cc ,..1 , l, e7 r(u_irl(i. 1.7 LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: M4O4.--/ RV) c ' 1, ± OWNER MAILING ADDRESS: ?25 ( C Co q C3 ( S' r S CIS ' -I Go , 7 /(-1-7 ( c OWNER PROPERTY ADDRESS: 1 t TELEPHONE NUMBER OF CONTACT PERSON: 67 ( — d p 1 TAX MAP NO. : Section N Block / Lot 7/0,_ CROSS STREET: i•-•; - BUILDING PERMIT NUMBER CROSS REFERENCE: N. gna/ tu/ofApat RECEIVED BY: ilTowq Clerk's Office " -y' DATE: (Z -t- cif( 9 0 _ _- -{+, lo- ,F+:';J�'-n-'- 1- —:2+.. +,'�r•'c.-i+r.r. �:g1��tgaa . +q' • = ' ',' SUFFOLK CO. HEALTH DEPT..APPROVA�' t;�;'._ ��., '' H.S. O. .'•;mar ;re E. -,<.;:‘-,-.:4 te., ,4=Z ,' .� r F A,. •` - - - ' . _ .V.i:t,.r�? �.r. y. ..�•- •' +►l�sB.�yiy��,py' " - 1j` , . ' y •'A.>,r.b.: w "'�Y';J rf e.-�g iei�..i. a �;` _ - `r-4,j. ILitil<1.1. ,',.'', ' T5ESLtLC> ;�'- - ,t _ AT --, ',.. .,:',.-:-..2.:‘ • i - . STATEMENT OF INTENT - :` <"' r ''''.,:',..i'.1',-,;•.:.',`1,';',':''''-7,:At2� `,F ` • THE WATER SUPPLY AND SEWAGE DIS j, .< i".'•�,.��:., r _ r, .�.. SYSTEMS EMS FOR THIS RES1O CE-,�JY.�a -0 V : CONFORMTO E 'i Y; _ -�- nji SUFFOLK CAtail • POF Y�f��i E '(-�ES�` .' .•- VL CANT ; 'SUFFOLK COUNTY DEPT.. •F ;HEAI,:T01'_ ` sy OR" APPROVAL 5 E R VICES . - _CONSTR �D . � �; DATE. . _ `' , ( ' H. S. REF. NO.: A �4 ^ ' /�, , �' `� :� Vii__ • _ � o3g8' o - ,, W t SUFFOLK CO_ TAX MAP DES CONATION: / - , , DIST. SECT. • BLOCK • ty -PCL. 0.-4 1' :_. 1000 . _.. f OWNERS ADDRESS: ,, .i' - , h. 32 GLEN_GQ ,:,=._.t;A°;'>. :ECRL"�•50'=I - •_ T,., f- ••:AR 'C ,�1$45.F.--' ., DEED: L.,, _ P _ ' ”. .'. ,,.7,,.7.7,.7' z ../...2.,::„.:..).-c:',,,,,j = • TEST HOLE .',' ' ' Ito,e,-''scr z.+.e.elt:, *'tor or a itiolt=z` �, t •totviss'.,,.,p'isnv-n;strnnof`-`} + . t' -;•.,-Z!--'-'!. .-4;,1,',,, ,',',',';',' Y , =cc io}f' `h�.of the New Vor'r.,St a `• '?,lr�°`+ . ,,,-,1-;:, - • /fit p ,r rdvcation CaW.-. 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