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JUDITH T.TERRY ; o Town Hall,53095 Main Road
TOWN CLERK g P.O.Box 1179
REGISTRAR OF VITAL STATISTICS ‘:°' 4. $ Southold,New York 11971
MARRIAGE OFFICER \.# o I' Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : J •"„1•' Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,osg.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1271 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
ADDITION 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 TERRY, MAUREEN F.
Mailing Address 1 1780 VILLAGE LANE
City St Zip ORIENT NY 11957
Property Address 1 1780 VILLAGE LANE
City St Zip ORIENT NY 11957
Tax Map No. section 24.00 block 2 lot 19.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 1/19/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
JUDITH T.TERRY % ® % o n Hall, 53095 Main Road
TOWN CLERK 1 ca k , r M ; �' E .11;115
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REGISTRAR OF VITAL STATISTICS •� `Q ' �' I, :` ty a•.York411971
ego • '' Fax(516)76 -p1823
MARRIAGE OFFICER � `T ,p-/ �o
RECORDS MANAGEMENT OFFICER =_ ®l 0 �„d� �Pelephoe 16 7651800
FREEDOM OF INFORMATION OFFICER ----...„,,,••.° JAS r �$
BLDG.DEPT
TOWN OF SOUTt.OLD
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: January 3, 1995
Transmitted herewith is a copy of application No. 1318 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
- Morris Cesspool for Maureen Terry
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.
--7
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - c' - A:CAUTION INSPECTION
DISAPPROVE - REQUIRED
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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BLDG DEPT. 4 Date
TOWN OF SOUTHOLD
OFFI F THE TOWN CLERK ,,,,,,,,,,,
Town of Southold ,,'IltFoure- _ k
`Judith T. Terry, Town Clerk , , Application No / (�
Town Hall, 53095 Main Road �� 41, Construction
P. O. Box 1179
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Southold, New York 11971 N Alteration
Telephone ‘`V-A, Air $10.00 - Residential
(516) 765-1801 = ®1sit
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�,,,•,, $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 Jna i / Ty
APPLICANT NAME:
APPLICANT ADDRESS: 27, 4, Q�
/1KSEPTIC CESSPOOE'{
DESCRIPTION OF P'OPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: "CO /P/c,(4/ 7‹. )cf e/
OWNER MAILING ADDRESS: 7.C>
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: e/erS
TAX MAP NO. : Section j� Block Lot 7.?
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignature of Applicant
•
RECOVED
RECEIVED BY :
JAN Tov3n' }erk's Office
DATE: luso Clerk bf1U1d
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