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JUDITH T.TERRY ; �� Town Hall, 53095 Main Road
TOWN CLERK t P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ��% �, Southold,New York 11971
MARRIAGE OFFICER ��44 ��/��� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER ®fir ED ?o fd Telephone(516)765-1800
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. 1364 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
INSTALLATION OF AN OVERFLOW CESSPOOL 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 TENEDIOUS, STEVE
Mailing Address 1 690 NORTH SEA DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 690 NORTH SEA DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 5 lot 15.000
Cross Street KENNYS ROAD
Building Permit Number Cross Reference:
- Issue Date: 8/10/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
`� O
Iii
JUDITH T.TERRY t
o % Town Hall,53095 Main Road
%TOWN CLERK % chi P.O.Box 1179
��� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �1 Fax(516)765-1823
MARRIAGE OFFICER ® ®l Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER �i
FREEDOM OF INFORMATION OFFICER „„ ,•oi
OFFICE OF THE TOWN CLERK :,,'''.s
TOWN OF SOUTHOLD ,, -
TO: Southold Town Building Department ,,�`
•a(9 ,1>` , >
FROM: Linda Cooper, Southold Town Clerk's Office ` ''�l' ' ®, �`�:'`
DATED: August 10, 1995 `\ 4 ' f'
Transmitted herewith is a copy of application No. 1423 for an `",: „
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Steve Tenedious
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. 4
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - `�_
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
,r7-:)--,47 .e5.1.-2,,,,je
Signature
Date ` IA 9r
„P
OFFII'E;EBF THE TOWN CLERK
Town of Southold � Application No.
sose f Ut/( +
�'�� �a 3
Judith T. Terry, Town Clerk � l/*
Town Hall, 53095 Main Road �� Construction
P. O. Box 1179 rie-` Alteration /
�
Southold, New York 11971 !if;
Telephone ����►�'s, $10.00 - Residential JJ
(516) 765-1801 _ 1 4 ,, ''� $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
r
APPLICANT NAME:
APPLICANT ADDRESS: 27” / ; yD�
)- , V
SEPTIC CESSPOOL_V
DESCRIPTION OF PRO'OSED CONSTRUCTION Or ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION, OF PROPOSED CONSTRUCTION OR ALTERATIO► :
OWNER OF PROPERTY: (S-7��i�-e j ,
OWNER MAILING ADDRESS: C'gD
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7K7r-
TAX MAP NO. : Section Block � Lot /S
CROSS STREET: /%
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1-7
BUILDING PERMIT NUMBER CROSS REFERENCE:
2') y4
ignature of Applicant
RECEIVED BY: , °
Town 'Clerk's Office
DATE: V,/e.ycjc
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