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JUDITH T.TERRY ; Town Hall, 53095 Main Road
CD TOWN CLERK t g t P.O.Box 1179
PirV Southold,New York 11971
REGISTRAR OF VITAL STATISTICS t O Q �1 Fax(516)765-1823
MARRIAGE OFFICER Li ® 1
RECORDS MANAGEMENT OFFICER •: ®i 1��i� 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. 1374 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 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 VANDENHEUVEL, STANLEY
Mailing Address 1 3957 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 SAME
City St Zip 0000
Tax Map No. section 78.00 block 3 lot 12.001
Cross Street BAY WATER AVENUE
Building Permit Number Cross Reference:
Issue Date: 8/21/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
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JUDITH T.TERRY -6 `� Town Hall, 53095 Main Road
TOWN CLERK 4 P.O.Box 1179
t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS � C> Fax(516)765-1823
`
MARRIAGE OFFICER �s2 ® 1
RECORDS MANAGEMENT OFFICER ®I D ��sd, ' Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ���,,,,,�•��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: August 21, 1995
Transmitted herewith is a copy of application No. A1428 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Stanley VanDenheuvel
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.
s
:g.7
Signature
8/2-1
Date
OFFICE 8F THE TOWN CLERK ,,,'""'"'
Town of Southold .�'�10FD(Ke
Judith T. Terry, Town Clerk ,�'��� �l/y=. Application No. /�Aire
Town Hall, 53095 Main Road = Construction
P. O. Box 1179
Southold, New York 11971 :213 r Alteration
Telephone 0-4':V"
/����' $10.00 - Residential
(516) 765-1801 = 1 ', ,'0. $25.00 - Non-Residential
--- il'
TOWN OF SOUTHOLD
' SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 4 / M-5-
1
APPLICANT NAME:
% JC
APPLICANT ADDRESS: 7,�e /. � �v , A)
SEPTIC CESSPOOL
DESCRIPTION OF PR• - SED CONSTRUCTION • i ALTERATION '
/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERAT N:
OWNER OF PROPERTY: 72,4 &
„7,7,
OWNER MAILING ADDRESS: ?75' j,- %e/6.2.41-C 7.4_
______ Fey ,,,, r yy„,
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: (725C
TAX MAP NO. : Section 7? Block_ Lot /2_ / s
CROSS STREET: V) a-,&_. 1
BUILDING PERMIT NUMBER CROSS REFERENCE:
,,,A,..
„i - , . '
tgnature of Applicant
RECEIVED BY: (A./XjA----L-i
own Clerk's Office
DATE: g12.-( 7,,s—