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Town Hall, 53095 Main Road
P.O. Box 1179
ite0►►1 Southold, New York 11971
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JUDITH T. TERRY ������#"0° TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 494 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : NEESE, JAMES R.
Address 1 : P. O. BOX 126
City St Zip SOUTHOLD NY 11971
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 4/19/89.
Name Of Owner NEESE, JAMES R. AND ELLEN M.
Mailing Address 1 P. O. BOX 126
City St Zip • SOUTHOLD NY 11971
Property Address 1 PARK PLACE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 56.00 block 1 lot 2.014
Cross Street POND AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/10/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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BLDG,REPT. Lin k t4 x't;=' ��.� Town Hall, 53095 Main Road
2WN OF SOUTHOLD �'` •� P.O. Box 1179
_ ,�� �, e� ��I Southold, New York 11971
JUDITH T.TERRY � �, TELEPHONE
TO\VN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: May 8, 1989
Transmitted herewith is a copy of application No. 505 for •a Cesspool/
Septic Tank Construction Permit submitted by:
James and Ellen Neese
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 DC
DISAPPROVE
Comments: . �' c �L JJ C9LD rk.
C)LasS
Signature
Dated
OFFICE OF THE TOWN CLERK O
Town of Southold Off. ;r ` . lj
Judith T. Terry, Town Clerk �F � , ► - Application No.
Town Hall, 53095 Main Road t ;� '� Construction
P. O. Box 1179 ti
, `% g71-4 Sj Alteration
Southold, New York 11971
Telephone
(516)
lytO Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /Od 07)
DATE CS--/2//7 7
APPLICANT NAME: --_1,L/4Ef .
APPLICANT ADDRESS: ?Q gX 1„2, , 162s- OAKkei/ 'N AvE.
Sc (771-4 01-57)j N. • 1. 1611 I
SEPTIC CESSPOOL )
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
i\lEu COAI2TOuCT JQA1 OF 3i ii1E ,E1), (r4 it
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY: .4A/ 7 _
OWNER MAILING ADDRESS: )? ox 4wkAe4_,A1 Ave-.
N.V. l/Q`71
OWNER PROPERTY ADDRESS: Ri'RK ),AC%
;ivy-'/ IMI1
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 56.% Block / Lot oil. /
it
CROSS STREET: ►. L ot'lD AVE.
BUILDING PERMIT NUMBER CROSS REFERENCE:_
AZai 2 .ee,14
Signature of pplicant
RECEIVED BY:
REMq own Clerk's Office
DATE: Y 0310
SUFFOLK CO.HEALTH DEPT.APPROVAL
H.S. NO.
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t \\ / STATEMENT OF INTENT
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1,6 \ � - THE WATER SUPPLY AND SEWAGE DISPOSAL
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N 70'38.50"E. f , C)I �" ? / SYSTEMS FOR THIS RESIDENCE WILL
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j! — - � �i / CONFORM TO THE STANDARDS OF THE
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.;� SUFFOLK CO DEPT. OF HEALTH SERVICES.
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;Z,r tY, ?‘ 0�1PI `0 ��" / APPLICANT
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j SUFFOLK COUNTY DEPT. OF HEALTH
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SERVICES — FOR APPROVAL OF
II
CONSTRUCTION ONLY
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t 4-` <1' (1-' 44' 1000 056 I 2.14
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/ OWNERS ADDRESS: �I,Q(1 (�22�e
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__i , 1625 OAk.LAwN AVE.
`, / - m ‹e" .7Ou'?50'0 . I - �— 37.83 I SOUTHQLD,N.�I. 11971
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POND 5p ` .4' AVE1IL)E_ Jf la •
76S 3725
(PRIVATE ROAD)
DEED: L. 1!A P.
l4 TEST HOLE STAMP
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`_"t./'t.)i 1-kOL D LONG 15LAND tip f2TaAGE CORP. AND
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