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JUDITH T. TERRY AT Town Hall, 53095 Main Road
TOWN CLERK ° G+ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�� Southold, New York 11971
MARRIAGE OFFICER �® �� Fax (516) 765-1823
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,,ssemZ,, Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1022 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SAMUEL WILKINSON
Address 1: 1150 WATERVIEW DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
INSTALLATION OF AN ADDITIONAL CESSPOOL RING TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. KEEP 10' APART. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner WILKINSON, SAMUEL
Mailing Address 1 1150 WATERVIEW DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 1150 WATERVIEW DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 7 lot 26.000
Cross Street MAIN BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 7/08/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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At JUDITH T. TERRY4. Town Hall, 53095 Main Road
TOWN CLERK ® t,, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r:gl
$ Southold, New York 11971
MARRIAGE OFFICER ties® O v 0 Fax (516) 765-1823
��® ��®,�!' Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD bil.t ----ici.fir--7,77,1,
TO: Southold Town Building Department ,' ie ,°'
FROM: Linda Cooper, Southold Town Clerk's Office I Jt1L - 11 1993 p;,';
DATED: June 30, 1993 =--°___ ,-
• Transmitted herewith is a copy of application No. A1051 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
' Samuel Wilkinson .
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. oP
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
/
COMMENTS: _'1( /, /L_X' �. /
JUL 8 ,. .s,
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a`'EQUOIED Signature
Dea01-1 -_,,,1 9 3
OFFICE OF THE TOWN CLERK ,,,'""
Town of Southold ,s" 001.1re� /05-/
Town Clerk �' ®� ®� Application No.
Judith T. Terry, �, �'
Town Hall, 53095 Main Road ; , ', s,. Construction
P. 0. Box 1179
Southold, New York 11971 Fr' r",: Alteration
Telephone =�o,�; Qi1 $10.00 - Residential
(516) 765-1801 Ql � '0� $25.00 -Non-Residential
• ,110
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE -' - 7��
APPLICANT NAME: 6 1"7/ /i,/, 50"(
APPLICANT ADDRESS: //j-O 7-Eo vt ;L-eii Q, ,
SOUTI-10Lb /SCt // -7 (
SEPTIC CESSPOOL ,X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
ztisi•�ii �dd, Toj. / C spoof e:As
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: i g _ L bit
OWNER MAILING ADDRESS: //6-0 k/,q.72E-iev r- (/Z .
OWNER PROPERTY ADDRESS: SA- ,E'
TELEPHONE NUMBER OF CONTACT PERSON: 7 „23 cE R kcalk
TAX MAP NO. : Section 7 Bl,ock Lot c=.7 ,,
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
SignatureApplicant
RECEIVED 0(F'3
BY:
TowRe Office
DATE:
JUN 3 f4..�