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JUDITH T. TERRY ' i Town Hall, 53095 Main Road
TOWN CLERK ® " i P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS n ° 1'
MARRIAGE OFFICER s �� Fax ne (516)765765-1
� Telephone 765-1801
RECORDS MANAGEMENT OFFICER = ®,Q ,i�
FREEDOM OF INFORMATION OFFICER �� �irori
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1135 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 AND 2r ABOVE GROUND WATER.
IMPORTANT: EXCAVATION INSPECTION REQUIRED]]]
Name Of Owner V I OLETT, ELLEN
Mailing Address 1 CEDAR POINT DRIVE EAST
City St Zip SOUTHOLD NY 11971
Property Address 1 CEDAR POINT DRIVE EAST
City St Zip SOUTHOLD NY 11971
Tax Map No. section 90.00 block 2 lot 17.000
Cross Street CEDAR BEACH ROAD
Building Permit Number Cross Reference:
Issue Date: 5/24/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL
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JUDITH T. TERRY . Town Hall, 53095 Main Road
TOWN CLERK r1 P.O. Box 1179
vs WSouthold, New York 11971
REGISTRAR OF VITAL STATISTICS "210 I Fax (516) 765-1823
MARRIAGE OFFICER ---4 -00 ,t Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER _ 1 �/
FREEDOM OF INFORMATION OFFICER „viti/11-
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ,
__ TO: Southold Town Building Department
MAY ( 7 199
1-031EMEOWNLI
FROM: - Linda J. Cooper, Southold Town Clerk's Office ,
, DATED: May 16, 1994 BLDG.DEPT.
TOwN OF SOUTHOLD
Transmitted herewith is a copy of application No. A1174 for a Cesspool/
Septic Tank Construction Permit submitted by: , _
- r Morr'is_e _spool Services a/c FIIen \Iiolett • '
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
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE BION EXCAINSPECTION
DISAPPROVE VAU%REO
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OFFICE OF THE TOWN CLERK ,�,'""""'-
Town of Southold e C))Fl01k'`'® = Application No. // 7
Judith T. Terry, Town Clerk o'
Gam•
Town Hall 53095 Main Road � " Construction
P. O. Box 1179 ; a �`"
Southold, New York 11971 _ �•,�• Alteration
TelephoneO,j• �Q�s�• $10.00 - Residential
(516) 765-1801 '1 �, �' $25.00 -Non-Residential
TOWN OF SOUTHOLD 0✓'"
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE fit, / K/9 V
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APPLICANT NAME: /..-270,69(3 / S���c��
APPLICANT ADDRESS: 20 , o"
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SEPTIC CESSPOOL/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION R ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: : �� .� ?dt
OWNER PROPERTY ADDRESS: /
TELEPHONE NUMBER OF CONTACT PERSON: 76 ,5--
TAX
6s=TAX MAP NO. : Section V Block, Lot
CROSS STREET: (9 ) j />
BUILDING PERMIT NUMBER CROSS REFERENCE:
9/ a.rt
/ •'w/ c
/ Signature of Applicant
RECEIVED BY: /66
Town Clerk's fice
DATE:
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