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JUDITH T.TERRY 1��® Town Hall,53095 Main Road
TOWN CLERK k - P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS � Q Southold,New York 11971
MARRIAGE OFFICER 9, •®� '.� Fax(516)765 1823
RECORDS MANAGEMENT OFFICER ®i � ��1� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER .."'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1385 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOAN ELIZABETH WELLS
Address 1 : 5950 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITON OF CESSPOOL TO AN EXISTING SYSTEM
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner NELSON, GRACE E. AND WELLS,
Mailing Address 1 JOAN ELIZABETH
5950 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 5950 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 12 lot 2.000
Cross Street DEEP HOLE DRIVE
Building Permit Number Cross Reference:
Issue Date: 9/11/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/ 3
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JUDITH T.TERRY o Town Hall,53095 Main Road
TOWN CLERK gg, P.O.Box 1179
n57 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 0 �1 Fax(516)765-1823
MARRIAGE OFFICER ; ® 1
RECORDS MANAGEMENT OFFICER 1t�� $,,, Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER „„ ,so
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1' ;,i, ig
OFFICE OF THE TOWN CLERK i
TOWN OF SOUTHOLD ! I 1 ��� d
TO: Southold Town Building Department - --_----- _-- -- -� I
fLL( . &AL1='
FROM: Linda Cooper, Southold Town Clerk's Office ii=_ ��s°?J�F3 SCAJ°Hoi-D_s
DATED: September 6, 1995
Transmitted herewith is a copy of application No. A1437 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Joan Elizabeth Wells (work by Scott Albrecht)
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
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
J it • Ld'��o c
Signature ior
9 s�
Da -
QFFICEr+OF THE TOWN CLERK ,,,'"""''•
Town of Southold ,io'cOF(VON f`
Judith T. Terry, Town Clerk ,'' G Application No. ��` 7
Town Hall, 53095 Main Road ;� - Construction
P. O. Box 1179 'c ` Alteration
Southold, New York 11971 y '�.�
0 + $10.00 - Residential /G
Telephone *0/ O _
ad
(516) 765-1801
~ 0,,� 'I' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE rr f . !►
APPLICANT NAME: qe LV/z Ie V(..2/75'
APPLICANT ADDRESS:S 9S U /,4,1) _5-WA I 4 C°
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
77
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 4.-.a ce /VP /so, _ boa i L; ze, //�
OWNER MAILING ADDRESS: 4-0 /4'� �. � M ✓ P
le a7i ' / ✓ c /`� r /� � // �---„
OWNER PROPERTY ADDRESS: a /So ✓ -e
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section //5 Block
/ '2v- Lot 'Z_
CROSS STREET: bP p' r- P
BUILDING PERMIT NUMBER CROSS REFERENCE:
.�-
t
.4111
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
NEW S.UFF�:I.IL AVENUE •
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