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JUDITH T. TERRY % - Town Hall, 53095 Main Road
TOWN CLERK ® P—r=e P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971 .
�' 516
MARRIAGE OFFICER ® ®�' Fax ( ) 765-1823
,y®1 �1� �' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1059 R Residential X Non-Residential
Fee $ 10.00 " Septic Cesspool X
PERMIT ISSUED TO:
Name : AGNES WILLIAMS
Address 1 : 197 MERRICK AVENUE
City St Zip MERRICK E NY 11566
Descripton of Proposed Construction or Alteration
TWO POOL ALTERATION TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS AND PROPERTY LINES. EXCAVATION INSPECTION REQUIRED.
Name Of Owner WILLIAMS, AGNES
Mailing Address 1 197 MERRICK AVENUE
City St Zip MERRICK NY 11566
Property Address 1 480 BETTS STREET
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 110.00 block 6 lot 10.000
Cross Street GLENWOOD ROAD
Building Permit Number Cross Reference:
Issue Date: 11/10/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY ,0 . . Town Hall, 53095 Main Road
TOWN CLERK z, O T_, P.O. BOX 1179
REGISTRAR OF VITAL STATISTICS , IP �` • Southold, New York 11971
t Fax (516) 765-1823
MARRIAGE OFFICER ®� r
'y®/ 0 os' Telephone (516) 765-1801
OFFICE OF THE TOWN CLER r �,:,, =,a
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TOWN OF SOUTHOLD I', 111----,,_:,-..,
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li:,` 9 1993
TO: Southold Town Building Department €?i;i ®�
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FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 1, 1993 _,. . `�`
Transmitted herewith is a copy of application No. A1090 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Agnes Williams
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: pp
APPROVE - !� °.CAVATI®N INSPECTU
DISAPPROVE - REQUIRED
COMMENTS: ��.....p.,--------- - ---
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Date
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1---;OFFICE OF THE TOWN CLERK ���,
Town of Southold pC�Cr�(,�-^ -
Judith T. Terry, Town Clerk C` ' '- ._,,,� � �"
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'.c �'_ Application No.
Town Half, 53095 Alain Road !: `j""• '�+ �
P. 0. Box 1179
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v' �'`t:%, fiConstruction
Southold, New York 11971 K:: -�r
Alteration V'
Telephone '°l x P\C%C4
(516) 765- 1301 Residential
I'LL,
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT D '
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SEPTIC TANK or CESSPOOL ; f V I) °.-" 3
Permit No, 990110)0 Town Clerk
Fee •$
DATE //1- 7-9_3
APPLICANT NAME: / U�-e� 1..-1 `&i-L-75-
APPLICANT ADDRESS: %0 6-e. •
Coy-- a6-`
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION -MAP: Must be attached hereto before
permit may be issued.
LOCATIOI`I OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ,41-- -,_....,.___,- � 4! l '
• OWNER MAILING ADDRESS:
7 -err/c
OWNER PROPERTY ADDRESS: Y'Fv /6 1.7---f- J_/' /
C v%c- i e, G-r��_
TELEPHONE NUMBER OF CONTACT PERSON: 225
TAX MAP NO. : Section //D./C.� Block Lot f0
CROSS STREET: -7.-e---1--ood__ mac/ •
BUILDING PERMIT NUMBER CROSS REFERENCE
•
Signature of
•
Applicant
RECEIVED BY: i
Town Cler c's Office - ,
DATE: 1 1 J ' •I - q .
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