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JUDITH T. TERRY ATIrTown Hall, 53095 Main Road
TOWN CLERK O P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS :
� Fax (516) 765-1823
MARRIAGE OFFICER
w ��!' 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. 769 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RAYMOND F. NINE
Address 1 : 855 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
INSTALL NEW OVERFLOW POOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. EXCAVATION INSPECTION REQUIRED. CALL SOUTHOLD
TOWN BUILDING DEPARTMENT (765-1802) FOR AN APPOINTMENT.
Name Of Owner PALAZZOLO, FRANK AND ROSE
Mailing Address 1 3905 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 3905 PEQUASH AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 137.00 block 2 lot 19.006
Cross Street FLEETWOOD ROAD
Building Permit Number Cross Reference:
Issue Date: 10/18/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
76"t..9
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'ii''---*P-'' %', ( P.O. Box 1179
P.� -- ,y_ Southold, New York 11971
JUDITH T. TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF/THE TOWN CLERK
TOWN OF SOUTHOLD
October 10, 1991
To: Southold Town Code Enforcement "Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A790 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Raymond Nine for Frank and Rose Palazzolo
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 - X
DISAPPROVE -
COMMENTS: CL . .._r :+�► _.0_ . moi 0
\ill" i. $ ei -
� ,- ' Signature
Sr I ®r G 9 ‘ '
Date p
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Town Hall, 53095 Main Road
• ��:� P.O. Box 1179
i -, Southold, New York 11971
•JUDITH T. TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OFT THE TOWN CLERK
TOWN OF SOUTHOLD
October 10, 1991
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A790 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Raymond Nine for Frank and Rose Palazzolo
• 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 arid make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS:
Signature •
•
Date •
(-)p (, co E,O /Q --b Y
---A)F =ICE OF THE TOWN CLERK ,,
Town of Southold �
Judith. T. Terry, Town Clerk ' G ' Application No.
Town Hall, 53095 Main Road • Construction
P. O. Box 1179 = .- 'm :
zo -Southold, New York 11971 in _.r Alteration /
Telephone - D .i�, $10.00 - Residential
(516) 765-1801 - 1 I , �' $25.00 - Non-Residential
,,,
TOWN QF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT °
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or,CESSPOOL
Permit No.
Fee $ h i
DATE
APPLICANT NAME: , �' 'IV" 'Vr 4-
APPLICANT ADDRESS: '$J /vim' f' , (y F Fly,- i-yE
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION 'OR ALTERATION
1 Iv 5 T/l L L 91i°E v ')L'' 4' J/-t-6, ) 196' t/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: f - rn► k ' OSe qj!azz01
OWNER MAILING ADDRESS: 5 1p-o,c (2)-5
OWNER PROPERTY ADDRESS:_39a5 P "a Sk e n5kP
c.(k a t4- -, nJ , 1 1cv5
TELEPHONE NUMBER OF CONTACT PERSON: aoa ?e-02r •
TAX MAP NO. : Section \3"7 Block �, Lot ( 9
CROSS STREET: f j.pt 7- J,/ G#f /fa �t0
BUILDING PERMIT NUMBER CROSS-REFERENCE:
f1,17fr4
Sig a"/e of A.p'scant
RECEIVED BY: CMD f -
Town Clerk's Of ice
DATE: -- OCT 1 (' 1991
Town Clerk SouU of
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