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001
Town Hall, 53095 Main Road
JUDITH T. TERRY '
TOWN CLERK ® P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER �' �' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '_ ®1 ��
FREEDOM OF INFORMATION OFFICER = iv"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1165 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL SERVICE
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 SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, WATER BODIES AND MINIMUM OF 2' ABOVE
GROUND WATER. EXCAVATION INSPECTION REQUIRED.
Name Of Owner OWENS, PETER
Mailing Address 1 1675 CEDAR BEACH ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 1675 CEDAR BEACH ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 89.00 block 1 lot 6.000
Cross Street BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 7/20/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
coFOLA-40.4
JUDITH T. TERRY .G Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
un i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �® �. ," Fax (516) 765-1823
MARRIAGE OFFICER 4 $® �1' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 7Ql it -
FREEDOM OF INFORMATION OFFICER „,id,1 �'l,
IU U o d E
OFFICE OF THE TOWN CLERK ! ri,31 � , ..
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k-i( TOWN OF SOUTHOLD � JUL 7 1994 ���
Ui
`TO: Southold Town Building Department
(� BLDG.DEPT.
` 1 xV FROM: Linda Cooper, Southold Town Clerk's Office - TOWN OFSOUTHOLD
U DATED: July 6, 1994
•
Transmitted herewith is a copy of application No. A1209 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
�? MOrris Cesspool for Peter Owens
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.
64-✓tZe-e-
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - Z---------
EXCAVATION INSPECTION
DISAPPROVE - v'EQUYP
, ,.
COMMENTS: 0. �� a ,/ _ j
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. RECEIVED
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JUL 2 0 1994 . ;,_?5'Signature/' �- ` /
Town Clerk Southold
Dat7
OFF_10EE OF THE TOWN CLERK ,.,,""" -., 11 •
Town of Southold �•''O��F�O(xe'OG: Application No./c)--0
Judith T. Terry, Town Clerk �' •
Town Hall, 5305 Main Road ;�' `
_ Construction
P. 0. Box 1179
Southold, New York 11971 ;��c�t7 ,' Alteration
Tele hone � ,f $10.00 - Residential
(516) 7p65-1801 ' �1 44 -1‘ '' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
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APPLICANT NAME: /06'(- CES-57,,,/
APPLICANT ADDRESS: 274o " /O0!/z•c z Tl
� l /4r
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: . Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: / . •
4110 -
OWNER MAILING ADDRESS: 1/X-75-- 62e2.e„..„
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4
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: PX-5-7---;_.. .?6-6
TAX MAP NO. : Section ? Block / / Lot
CROSS STREET: 6,cdr-t'�
BUILDING PERMIT NUMBER CROSS REFERENCE:
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(Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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