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**-7:410 '$ Town Hall, 53095 Main Road
P.O. Box 1179
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Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 324 R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
PERMIT ISSUED TO:
Name : TUSA, SAL
Address 1: 6 MARLAN COURT
City St Zip SMITHTOWN NY 11787-0000
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM
APPROVED AS PER SUFFOLK COUNTY HEALTH DEPARTMENT APPROVAL.
Name Of Owner TUSA, SAL
Mailing Address 1 6 MARLAN COURT
City St Zip SMITHTOWN NY 11787-0000
Property Address 1 WILLIS CREEK DRIVE
City St Zip MATTITUCK NY 11952-0000
Tax Map No. section 115 . 00 block 17 lot 17 .150
Cross Street MEADOW BEACH LANE
Building Permit Number Cross Reference:
Issue Date: 4/15/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
'
OFFICE OF THE TOWN CLERK c�vFFO(.,r`-
Town of Southold, Town Clerk , : Application No. ��
Judith T. Terry, � ,�,. �,
� ,
Town Hall, 53095 Main Road ` o �' � � � �' "� ' Construction
P. O. Box 1179 ' `°
cn
Southold, New York 11971 ® �, Alteration
Telephone _ol - NO
0 Residential V
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
17
Permit No.
Fee $
DATE'. /file_ ���,k es
APPLICANT NAME: '
APPLICANT ADDRESS:' .4 /4RLA V74-pe4 A ' /1717
J �
SEPTIC /CESSPOOL V
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: Siop 775S79
OWNER MAILING ADDRESS: I M, RZ c / a,n. 4/,
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OWNER PROPERTY ADDRESS: A44,41. �i e',x /i,,tvie,'i9 /# -J—ci4A,
TELEPHONE NUMBER OF CONTACT PERSON:7 '/-' 1Ii
TAX MAP NO. : Sectionl/f Block g--0,424r—Lot =�=z' /745
CROSS STREET :/ 4t 1 ,e5)0/9e7-11 �p ,
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of App icant'
RECEIVED BY: t'`��!
o ;erk'•. Office
DATE:
0/768
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this residence will conform to the standards of �� I . 3
the Suf,folk County Department of Health Services.Ley /ZZ 4/G
�Tusa 3 "611 J
6 Marian Court ;. f rN\
Smithtown, N.Y. 11787 '
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