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JUDITH T. TERRY ; oma Town Hall, 53095 Main Road
TOWN CLERK + ; P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MR!RRIAGE OFFICER O �" •
Fax (516) 765-1823
- 1;b# � Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1054 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
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 WELLS,
BUILDINGS AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner OSTERMANN, LARRY
Mailing Address 1 BOX 1199
City St Zip SOUTHOLD NY 11971
Property Address 1 985 OAK AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 77.00 block 1 lot 11 .000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 10/28/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY '''e Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS �• Southold, New York 11971
•1 Fax (516) 765-1823
MARRIAGE OFFICER ® ®� •
I1 1-'+;i 'E. , ,J,6, a __.40 110 I0' Telephone (516) 765-1801
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\ .� OCT 1 31993
? OFFICE OF THE TOWN CLERK
:4. :. TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office -
DATED: October 13, 1993
•
Transmitted herewith is a copy of application No. 1085 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Larry Ostermann ,
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 -
r,`'CAVA11O iNSPECT1ON
DISAPPROVE - REQ MED
COMMENTS: � �� hiaa(Age 1471,0 We i M7_7_7 /
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Date
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-. ry, Town Clerk /044,' "-- ��� Application No.; 53095 Main Road � = Construction
r'. 0. Box 1179 ; v rn
Southold, New York 11971 ,V) -_ �,� Alteration
t Telephone -tP " Q�1�' $10.00 - Residential `—
(516) 765-1801 = �l � " $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ . _ -
DATE C%` lJ /;-- ._--- .
APPLICANT NAME: .i//'°7/'t-d p217r�-
APPLICANT ADDRESS: qC7. ,e_-__0(„ A
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SEPTIC CESSPOOL ,
DESCRIPTIONOF P OPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: .a./1/')7 ati '/�.7,� ,z-
OWNER MAILING ADDRESS: • ,(, dC ii57
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OWNER PROPERTY ADDRESS: 54,',.c/44/P /7/
. TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 77 Block / Lot //
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' CROSS STREET:
% , • ''l •'' BUILDING •PERMIT NUMBER CROSS REFERENCE:
' D . /• ,,r/4-2 -:'
ignature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
-5
AP)
IroN 4( 5
1371
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