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JUDITH T.TERRY � Town Hall, 53095 Main Road
TOWN CLERK ® Tki;-,, P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICSH (2) Fax (516) 765-1823
MARRIAGE OFFICER ��
RECORDS MANAGEMENT OFFICERr ®O' Telephone (516) 765-1801
FREEDOM OF INFORMATION OFFICER ;
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1247 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PAM MCCAFFERY
Address 1 : 2305 LAUREL WAY
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITON OF AN OVERFLOW 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 SMITH, MARION E.
Mailing Address 1
City St Zip 0000
Property Address 1 2305 LAUREL WAY
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 4 lot 18.000
1Cross Street ALDRICH LANE
Building Permit Number Cross Reference:
Issue Date: 11/28/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK ® , ' • P.O. Box 1179
VI Southold, New York 11971
REGISTRAR OF VITAL STATISTICS .1' Fax (516) 765-1823
MARRIAGE OFFICER _ � ��," Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = ���o ,....\
FREEDOM OF INFORMATION OFFICER —"•,�,,,,c/0 141 r
OFFICE OF THE TOWN CLERK vhf, C�
TOWN OF SOUTHOLD / /J/ 4
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TO: Southold Town Building Department )6 � /� \e
FROM: Linda Cooper, Southold Town Clerk's Office oc /`9�9 �� ',;F
DATED: November 17, 1994 sc?C- Q ,f;F '.
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Transmitted herewith is a copy of application No. A1293 for an ._`
ALTERATION PERMIT for a cesspool or septic system submitted by
Marion Smith (Renter - Pam McCaffery) by Ray Nine
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. moo.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation: sp�,p ��aa
APPROVE - , ch�°�i�1®N ill��lSPErTM
REQUMED
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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OFFICE OF TWE TOWN CLERK , -
Town of Southold ,"I c�Ff OLA(`'e7 2 3
Judith T. Terry, Town Clerk �' l/ Application No.
Town Hall, 53095 Main Road aO .= Construction
P. O. Box 1179 ; p 6mI v
Southold, New York 11971 • VI � ° � .`
Alteration
Telephone �y®,� • �•�, $10.00 - Residential
(516) 765-1801 ' ol tot.
$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
APPLICANT NAME: #4f/ 0/7-
O Ceiy1,c ce
APPLICANT ADDRESS: ,t,Svs ��u-/U A k14 /v
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: S7 t / S A-600 E
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: pa! —
TAX MAP NO. : Section J 07 / Block l Lot U
G
CROSS STREET: atce.A ,-L,
BUILDING PERMIT NUMBER CROSS REFERENCE:
Useg4,-/
Si2eofApplica #
RECEIVED BY:
Town Clerk's Office
DATE:
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