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JUDITH T.TERRY
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o Town Hall,53095 Main Road
TOWN CLERK C @I@ P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS :% 0 1, Southold,New York 11971
MARRIAGE OFFICER �� ��Q���� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER ®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. 1344 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 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 VANJI, ANNA
Mailing Address 1
City St Zip 0000
Property Address 1 17180 MAIN STREET
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 9 lot 29.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 6/01/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY f t t v� Town Hall, 53095 Main Road
`' ' a * P.O. Box 1179
TOWN CLERK ® res
44‘14',-. _;� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS c e� -A- ' r
MARRIAGE OFFICER t �' •�' Fax (516) 765-1823
4, - Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER `=�®j ..
FREEDOM OF INFORMATION OFFICER
-"-÷1----,��ii,,,,��,'Y
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Fes- --T---M--------- -...----_
TO: Southold Town Building Department {hE --_U L' _
FROM: Linda Cooper, Southold Town Clerk's Office ! !M F
O mAV3 ®1995 ,; 1'
DATED: May 30, 1995 r 'd t— ''
R G^ DEPT.
Transmitted herewith is a copy of application No. A1394 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Anna Vanji
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. °-e )
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;
D �., 6 i
Signatur-
MAY 3 1 1995
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town Clerk Southold Date ��`�/
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OFFICE OF THE TOWN CLERK ,,,'""'
Town of Southold o''ic3IFDk+�
Judith T. Terry, Town Clerk �''� Application No/ 3 7(//Town Hall, 53095 Main Road ;�0 Construction
P. O. Box 1179 Alteration •- '
i
Southold, New York 11971 cPt� T,'
Telephone � °,j�0 ��0�'�'�, $10.00 - Residential i..
(516) 765-1801 = 1 '��
' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE / (2 05/--
•
APPLICANT NAME: r / 1 -� % �
- r26,/- )-1
APPLICANT ADDRESS: 2j'A.-;-�d J�?J� � pe
77 ,
SEPTIC CESSPOOL ./
DESCRIPTION OF P"POSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: . /9/1-77 i'';52/?‘7/
OWNER MAILING ADDRESS: /7/Pd ' '\ ,
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OWNER PROPERTY ADDRESS:
LI -
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /77 Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
00- e' �7`,Z2%Arz
Sig ature of Applicant
RECEIVED BY: 4
own Cle ' 's Office
DATE: Sr -
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