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JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK : p rZ P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS i .� �` Southold, New York 11971
MARRIAGE OFFICER ���o ��0�,��, Tel Fax -1823
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(5 6) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1018 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 ADDITIONAL OVERFLOW CESSPOOL.
APPROVED AS SUBMITTED. INSPECTION NEEDED, PLEASE CALL WHEN INSTALLED.
Name Of Owner CARBEN, ROBERT
Mailing Address 1 P. O. BOX 89
City St Zip SOUTHOLD NY 11971
Property Address 1 3575 WELLS AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block ti lot 5.000
Cross Street OAKLAWN AVENUE
Building Permit Number Cross Reference:
Issue Date: 6/30/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : .G ; Town Hall, 53095 Main Road
TOWN CLERK : p rZ P.O. BOX 1 179
REGISTRAR OF VITAL STATISTICS , i!') Southold, New York 11971
MARRIAGE OFFICER y0 �- Fax (516) 765-1823
,yo ��� ..� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD s:
FILM
TO: Southold Town Building Department
1993
FROM: Linda Cooper, Southold Town Clerk's Office 2 5
DATED: June 25, 1993 WPJ�-_
TOWN Uc S
Transmitted herewith is a copy of application No. A1047 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
• Morris Cesspool for Robert Garben ,
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.
46----)c,e c..,-
Linda
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the followin recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: .—>l 4,4:1-.1.60,01 7�/t
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Signature
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OFFICE OF THE TOWN CLERK ,,,'"""
Town of Southold °1','O �f01./(0
Judith T. Terry, Town Clerk ;'�� l/ Application No.
Town Hall, 53095 Main Road Construction
P. O. Box 1179Alteration
Southold, New York 11971 �'
Tel h ,`�'4 ���� $10.00 - Residential
ep one
44417)65-1801 , o'e,, $25.00 -Non-Residential
JUN 4 TOWN OF SOUTHOLD
TOW Imo SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: fial1fs
APPLICANT ADDRESS: 2 ??Q `I' Oo
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONS UCTION OR ALTERATION acid
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
aff-OWNER OF PROPERTY: �e g/q�
OWNER MAILING ADDRESS:�� 4.4 I/
OWNER PROPERTY ADDRESS: i2-L-P
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 7O Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
/741
Signature of Applicant
RECEIVED BY:
Town erk's Office
DATE: S rl 3
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