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JUDITH T. TERRY �� �t�lV �' "- ' f Town Hall, 53095 Main Road
TOWN CLERK
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ' Southold, New York 11971
MARRIAGE OFFICER . ',, Fax (516) 765-1823
��® sz ! Fax
(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. 740 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : HENRY P. SMITH JR.
Address 1 : HOBART ROAD
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 7/1/91 .
Name Of Owner SMITH, HENRY P., JR.
Mailing Address 1 HOBART ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 420 POND AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 56.00 block 1 lot 37.000
Cross Street LAUREL AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/26/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY �!,� a et 1 Town Hall, 53095 Main Road
TOWN CLERK v' -s J g ii P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �. r •Z.3n r 4% Southold, New York 11971
MARRIAGE OFFICER fir' Fax (516) 765-1823
3 ��."� Fax
(516) 765-1801
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OFFICE OF THE TOWN CLERKI)
TOWN OF SOUTHOLD JUL I ;
July 18, 1991 ,.....
BLDG. DEPT. __,
To: Southold Town Code Enforcement Officer" TOWN OF SOUTHOLD
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. 762 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Henry P. Smith, Jr. .
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 - D(
DISAPPROVE -
COMMENTS: g,,, , e ,& 0,es ca 0.acx A.. 1 41-•
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Signature % 6g
-1\kko\CI ) JUL 2 6 1991
Date
CrFFICE OF THE TOWN CLERK �clFJ( C;'
' Town of Southold 0' C_ „°' OG
Judith T. Terry, Town Clerk ' F'- .L.')-^ ` � Application No. 76'72_
Town Hall 53095 Main Road o '" �• *• : — �•
U, Tx .'1 t.r,i Construction
P. O. Box 1179 ,..
Southold, New York 11971 a• Alteration
Telephone 1 r Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT ,
SEPTIC TANK or CESSPOOL
Permit No. Ile, '2
Fee $ 4
DATE ToLf /f /9?/
APPLICANT NAME: 1470 / a ',61711 eV,42
APPLICANT ADDRESS: 7461419/0C Ant)
K f , ,rC 4°: y', //9'7 I
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
j 'p ".OWNER OF PROPERTY: � i, °,4,9,� --Vier
OWNER MAILING ADDRESS: 4,67,64,7• )6,057/s
`co4,> 4 / f //Q.7/
OWNER PROPERTY ADDRESS: 4410 /2®/)/6 ~0
c. , , /d d fie. V. 1/91/
TELEPHONE NUMBER OF CONTACT PERSON: Q‘ - & 6 Clete
TAX MAP NO. : Section OS-4, Block 1 Lot 37
CROSS STREET: 6
BUILDING PERMIT NUMBER CROSS REFERENCE:_
a
/ ° , j .
S•9- nature of . `,..licant
RECEIVED BY: A, / ( ( AL e���
I g--797Town ler Ts Office , •
s
DATE: 7 9/
-4
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ion tru tion of a=:ii`i'i fe.;E ewcz=14 i�',�u�:ros, i 8 z~t4 F:O.i'1 COUNT': D n M r,,z SERVICES
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