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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
® � �� Fax (516) 765-1823
MARRIAGE OFFICER ��
RECORDS MANAGEMENT OFFICER -_�®1 °�1� i� Telephone (516) 765 1801
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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. 1083 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHN TUTHILL
Address 1 : P. O. BOX 192
City St Zip ORIENT NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APRPOVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #93-SO-93
Name Of Owner TUTHILL, LYLE AND RUTH
Mailing Address 1 P. O. BOX 192
City St Zip ORIENT NY 1195f
Property Address 1 21505 MAIN ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 17.00 block 4 lot 16.000
Cross Street OYSTERPOND LANE
Building Permit Number Cross Reference: 21845Z
Issue Date: 12/23/93 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
�' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Is�® a. �*
i' Fax (516) 765-1823
MARRIAGE OFFICER '---
on - �aa �! Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER 1 'l"
FREEDOM OF INFORMATION OFFICER „iiii,r���/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 7. _,_ ...------," ,..,,, ..... , ,—...,:
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1'J DEC 2 ® 1''
TO: Southold Town Building Department lint"
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FROM: Linda J. Cooper, Southold Town Clerk's Office �p� ;';� _� ;--'i3OL4 ^KK ',
DATED: December 20, 1993
Transmitted herewith is a copy of application No. 1118 for a Cesspool/
Septic Tank Construction Permit submitted by:
John Tuthill for Lyle & Ruth Tuthill .
Please review the application and location map and advise if the project
has received Suffolk County Health Department approval and if this office
may issue the permit.
Please complete the form below and return it to me.
Thank you.
Linda J. Cooper
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I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE //
DISAPPROVE
Comments: '. d �,,1 Y'e'7) 4" , 93 - Yo -. 9 3
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Signature ,
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Dated
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OFF,I•CE OF THE TOWN CLERK ,,cs\,^1;(/A
Town of Southold
4udith T. Terry, Town Clerk C' `Oi�.
�•.. Application No. /// r
Town Hall, 53095 Main Road ~ ,..t.;-j' --...1m,
• O. Box 1 179 �` Ftyu' �' ` rn Construction ��
Southold, New York 11971 O�' ^�' Y:
• �� �� Alteration
Telephone Ol x� �b-I Residential
(516) 765- 1301fix- Residential
Non-Residential
TOWN OF SOUTFIOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
for
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CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee •$
DATE f�
APPLICANT NAME: J6
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APPLICANT ADDRESS: 4 .2
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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:
OWNER OF PROPERTY: L. '
OWNER MAILING ADDRESS: /�`� K / G
OWNER PROPERTY ADDRESS: `-/ S v
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / 7 • Block
Lot
CROSS STREET: l
BUILDING PERMIT NUMBER CROSS REFERENCE:-
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104 ,6 C---', r ' / /
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ti Signature of .. •
Applicant
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RECEIVED BY:
("(-- --.
V owr Clerk's Office
DATE: ,
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