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JUDITH T.TERRY ����p� yj Town Hall, 53095 Main Road
TOWN CLERK ; ti 2 ; P.O. Box 1179
r'etREGISTRAR OF VITAL STATISTICS O
Southold,New York 11971
MARRIAGE OFFICER `�* Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER 1 �`� �� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER I,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1409 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 POOL 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 WHITEHEAD, JOHN
Mailing Address 1 8440 MAIN ROAD
City- St Zip EAST MARION NY 11939
Property Address 1 8440 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 7 lot 3.000
Cross Street BAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/27/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
io
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JUDITH T.TERRY �� _ y� Town Hall, 53095 Main Road
TOWN CLERK :% tiZ P.O. Box 1179
� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS •
1� Fax(516) 765-1823
MARRIAGE OFFICER '4 • ' • V• ��
RECORDS MANAGEMENT OFFICER 6.1 ������ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ,,•s°
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OFFICE OF THE TOWN CLERK I v111 '1 I =L5 = U~
TOWN OF SOUTHOLD L' 5 t, ;,I
r r OCT 2 5 1995
TO: Southold Town Building Department f
ff
FROM: Linda Cooper, Southold Town Clerk's Office
T01fJ�vOS
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t��:� tiC? p _7
DATED: October 25, 1995
Transmitted herewith is a copy of application No. A1462 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
- Morris Cesspool for John Whitehead
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.
411111111111.17Z4V--- 9
Signatu e ,
Date
•
i7 -
OFFICE OF TI;IE TOWN CLERK goo,$$$"'`'--
Town of Southold .1'" c0V01./(
Judith T. Terry, Town Clerk 4`'�, �liy � Application No41
Town Hall, 53095 Main Road ;� Construction
P. 0. Box 11792m
Alteration
Southold, New York 11971 too
Telephone ; ,j' $10.00 - Residential
r
(516) 765-1801 �l �;, $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE i()C14
APPLICANT NAME:
F-5
APPLICANT ADDRESS:
' /
SEPTIC CESSPOOL 7
DESCRIPTION OF P•O.OSED CONSTRUCTION OR ALTERATION
/i/
LOCATION MAP: 'Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: O///1 jj�J cV
. OWNER MAILING ADDRESS: ' /14- L'- 4,9
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:_ - 3 ?,,00
TAX MAP NO. : Section 3) Block
CROSS STREET: 14t2/ 79U
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: API A / ,
To lerk's Office
DATE: /05:77,
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