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OFFICE OF THE TOWN CLERK c.OFO(I(C,
Town of Southold 4(0.*
Judith. T. Terry, Town Clerk __—
Tow
GTown Hall, 53095 Main Road --
P. O. Box 1179 � '�.
Southold, New York 11971 O f ���-�••
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 141 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
PERMIT ISSUED TO:
NAME: William Wintjen
ADDRESS: Box 329
Sagaponack, New York 11962
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Gene Vanden Bosch
OWNER MAILING ADDRESS: County Road 48
Mattituck, New York 11952
OWNER PROPERTY ADDRESS : ROW off Grank Avenue
Mattituck, New York
TAX MAP NO. : Section 107 Block `S.. Lot 1 and 2
CROSS STREET: Grand Avenue
BUILDING PERMIT NUMBER CROSS REFERENCE:
Judith T. Terr
Southold Town C erk
DATE : April 7, 1987
(TOWN SEAL)
-
Town Hall 53095 Main Road
P.O. Box 1179
Southold, New York 11971
JUDITII T FERRY TELEPHONE•
TOWN CLI Rh - (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
April 7, 1987
William Wintjen
Box 329
Sagaponack, New York 11962
Re: Gene-Vanden Bosch
ROW off Grand Avenue
Mattituck, New YOrk
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25.00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
•
For your general _ information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly ours,
Judith T. Terry
Southold Town Clerk
Enclosures (3)
JTT/Ijc
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OFFICE OF THE TOWN CLERK
Town of Southold )
Judith T. Terry, Town Clerk
Application No./ /
Town Hall, 53095 Main Road Construction _
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone Residential _
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$ I O . O D
DATE 2d 3 / / �7
APPLICANT NAME: CA/'/ G 1----// ateI, ZA.,// k4o
APPLICANT ADDRESS: a X. 3 2.
P91--pe9,/ AL-&- -40/
•
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /-eJ
, -
•
LOCATION MAP: Must be attached hereto before permit may be issued.
-LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C— lPh �j ,7 -? 5
OWNER MAILING ADDRESS: Co cc_ f17 ileoe 1(6
illiti.$741Twak
OWNER PROPERTY ADDRESS: /U/,J Gam'
Q�7,(7,4z
,{), -72.,„„)
TELEPHONE NUMBER OF CONTACT PERSON: .S3 7 . 3 7�
TAX MAP NO. : Section / 7 Block ® Lot / -
CROSS STREET: 6—, 61-K1 �e
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEI'4 BJE
Town d erk's 0 fice
DATEAPR 0 3 1987
Town Clerk Southold
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