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JUDITH T. TERRY '' Town Hall, 53095 Main Road
TOWN CLERK ri,r14+ F P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
zr i Fax (516) 765-1823
MARRIAGE OFFICER =
RECORDS MANAGEMENT OFFICER _ % 1\19 ��� Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER - 1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1217 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : THOMAS A. PALMER
Address 1 : 2050 DEEP HOLE DRIVE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW TANK 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 PALMER, THOMAS A.
Mailing Address 1 P. O. BOX 218
City St Zip CUTCHOGUE NY 11935
Property Address 1 2050 DEEP HOLE DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 4 lot 5.000
Cross Street RICHARD PLACE
Building Permit Number Cross Reference:
Issue Date: 10/13/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/0,217
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JUDITIl T. TERRY : `, Town Hall, 53095 Main Road
TOWN CLERK ® kn t� P.O. Box 1179
trs .�� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � ;� Fax (516) 765-1823
MARRIAGE OFFICER _ej� ' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ®l o��
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK D
TOWN OF SOUTHOLD • SEP 2111994
TO: Southold Town Building Department
BLDG.DEPT.
FROM: Linda Cooper, Southold Town Clerk's Office TOVVN OF SOUTHOLD
DATED:
Transmitted herewith is a copy of application No. A1261 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Thomas A. Palmer
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.
-cLu'
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - f/
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
S'gnatu
Dafe
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OFFi.CE'OF THE TOWN CLERK ,,,'"""'v"-•-
Town of Southold sioIc % OLI j,
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Judith T. Terry, Town Clerk �� c ,: Application No. /..9_4(
Town Hall, 53095 Main Road ;► L Construction
P. 0. Box 1179I:=1 rn �
Southold; New York 11971 tt� yc Alteration
Telephone 0 • r./ ' $10.00 - Residential
(516) 765-1801 1 ��i.,
��,, • $25.00.--`Non-Residential
-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
,,,APPLICATION
` j` { for (1-\\
CONSTRUCTION' or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ f `
DATE �1a
-/ -020R, 97-
APPLICANT NAME: / //v) -r '' 0-! (✓v ✓(
APPLICANT ADDRESS: o�0S-Z7 .CJeC��p G c, 4,k)
mI9.rs J 7�c/Y J19 z-
SEPTIC be-CESSPOOL,
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto/before permit may be issued.
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LOCATION OF PROPOSED CONSTRUCTION OR ALTER ON:
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OWNER OF PROPERTY: oii'i4J Al 1 1 c)'l1J
OWNER MAILING ADDRESS: Paso), 1,
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OWNER PROPERTY ADDRESS: dos-0 be e, P h'o e U�
/4477) -7-a) 6 e
TELEPHONE NUMBER OF CONTACT PERSON: 477F,--to?-7J----
7,,
TAX MAP NO. : Section = [3lock ' 4 Lot
CROSS STREET: 1.?1 C R
BUILDING PERMIT NUMBER CROSS REFEREiCE: At al
Signature of Applicant
RECEIVED BY:
W•
To n Clerk's Office
'DATE: 1.)--3 9 Y'
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