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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK , Ytr .`4? �v" P.O. Box 1179
j =Y Southold
REGISTRAR OF VITAL STATISTICS ' � � � -``' v , New York 11971
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MARRIAGE OFFICER a r Fax 516( ) 765-1823
V0,7/ -- Fax
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. 680 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : EDWIN D. THATCHER
Address 1 : 654 MADISON AVENUE
City St Zip NEW YORK NY 10021
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY RESIDENCE WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 8/15/90.
Name Of Owner 172 DUFFIELD STREET, INC.
Mailing Address 1 654 MADISON AVENUE
City St Zip NEW YORK NY 10021
Property Address 1 STARS ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 3 lot 1 .000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 2/20/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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J , � P Town Hall, 53095 Main Road
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TOWN OF SOUTHOLD ^ ;:�".. ` '�'' 9 ,,,,,,,--„,:,,,,,y Southold, New York 11971
JUDITH T.TERRY4-z-,...:::_,_;.:y,:,=�" TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD _
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: 40-/i0219/
Transmitted herewith is a copy of application No. 700 for a Cesspool/
Septic Tank Construction Permit submitted by:
Edwin D. Thatcher for 172 Duffield Street, Inc. •
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 K
DISAPPROVE _
Comments: LL, J,,,,,0e_ati,A cTn car°.c
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Signature
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Dated
4
OFFICE OF THE TOWN CLERK ,,,'""'
Town of Southold . Application No. OD
'=.� ��FWire /
Judith T. Terry, Town Clerk !� % G.*
Town Hall, 53095 Main Road Construction L
P. 0. Box 1179 o ,�r, �
Southold, New York 11971 tt� ��4. Alteration
Telephoney,j�o - eZr $10.00 - Residential
(516) 765-1801 1 � ,, " $25.00 -Non-Residential
si_il,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
•
Fee $
DATE
APPLICANT NAME: A.0(A'` �'
APPLICANT ADDRESS: (a'4Av-e'
SEPTIC )( CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
\JPw `I7 PS I e_
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTIONOR ALTERATION:
OWNER OF PROPERTY: l�/ Du- (J 1 Q-(.
OWNER MAILING ADDRESS: (i) 34 Mac5v1",
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OWNER PROPERTY ADDRESS: 5 -etA- Tama!
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TELEPHONE NUMBER OF CONTACT PERSON: 212 --cMC-6172-6
TAX MAP NO. : Section/or- Z'Z Block 3 Lot I
CROSS STREET: _ � `111cc.v7,
BUILDING PERMIT NUMBER CROSS REFERENCE:
6,/,(AA- 72'6012A/111---
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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