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JUDITH T.TERRY ; ® Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICS 1� Southold,New York 11971
MARRIAGE OFFICER �� `r 0I� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : ®I ,s2 • .°14,00' 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. 1359 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 A 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 TWEEDIE, DONNA AND STEVE
Mailing Address 1 2806 RUSSELL ROAD
City St Zip ALEXANDRIA VA 22305
Property Address 1 825 STEPHENSONS ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 17.00 block 1 lot 11 .005
Cross Street VILLAGE LANE
Building Permit Number Cross Reference:
Issue Date: 7/26/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY ' : �L Town Hall, 53095 Main Road
TOWN CLERK z ® °Z P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS t'_ 1 X61" Fax (516) 765-1823
MARRIAGE OFFICER ®Ai - o�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER — ®1 .at
FREEDOM OF INFORMATION OF ER '�,r..."11/11/�l
0 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: July 17, 1995
Transmitted herewith is a copy of application No. 1411 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Donna Tweedie
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. \
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.
1
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RECEIVED Signat ' e if
JUL 241995D ���
a e
fon Clerk Southold
OFFICE OF THE TOWN CLERK ,,,'"""
Town of Southold soeictfULKI' 47///Judith T. Terry, Town Clerk �l/y=. Application No./
Town Hall, 53095 Main Road � O = Construction
a �C
P. 0. Box 1179 rin Alteration
Southold, New York 11971
Telephone ``0,t, �� � $10.00 - Residential
(516) 765-1801 = .�
'�
$25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 14 (7 /5)9r
APPLICANT NAME: 1/e4Vbe; i ''
APPLICANT ADDRESS:
/
SEPTIC , CESSPOOL �.
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
(71-freffier
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY: (5 /k 0E P0/11Ja
OWNER MAILING ADDRESS: ; 6- omereesvMP'► I 0 ,( 4_1 42
F 2S 57,6-ehk-'i2J ',JS ge32 /2/-K 2 236,5'
OWNER PROPERTY ADDRESS: 0 � ' i A- fr
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /7 Block / Lot /1- .5
CROSS STREET: , -17/01,/,( 4
BUILDING PERMIT NUMBER CROSS REFERENCE:
/G"-Cid'`
Signature of Applicant
RECEIVED BY: k
Town 'Clerk's Office
DATE: 7— /7 —�rJ
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