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JUDITH T.TERRY /0 y- Town Hall,53095 Main Road
TOWN CLERK P.O.Z P.O.Box 1179
REGISTRAR OF VITAL STATISTICS
�� Southold,New York 11971
Fax(516)765-1823
MARRIAGE OFFICER � O ���
RECORDS MANAGEMENT OFFICER .� �► ���� Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER -„-, ,,.01
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1324 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION OF AN OVERFLOW CESSPOOL 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 GOLDMAN, BILLIE
Mailing Address 1 500 WEST 43RD STREET, 17F
City St Zip NEW YORK NY 10036
Property Address 1 21995 SOUNDVIEW AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 135.00 block 1 lot 11 .000
Cross Street ROUTE 48
Building Permit Number Cross Reference:
Issue Date: 5/04/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
73y
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JUDITH T. TERRY Z `; Town Hall, 53095 Main Road
TOWN CLERK : p e=n P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS VO �� Fax (516) 765-1823
MARRIAGE OFFICER Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER s
' ����
FREEDOM OF INFORMATION OFFICER ....
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department APR A.. 1996
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: April 28, 1995
Transmitted herewith is a copy of application No. A1373 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool for Bille Goldman
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.
cz
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.
Signature
D e
s
OFFICE OF THE TOWN CLERK ,���""""' •
-
Town of Southold .0.1 C4\00tKeo _ Application No./��
Judith T. Terry, Town Clerk ,' % Gy
Town Hall, 53095 Main Road ��� _` Construction
P. 0. Box 1179 �,��•
Southold, New York 11971 i Alteration
Telephone '°! Qroes $10.00 - Residential ��---.._.
p •
(516) 765-1801 Ol .
, ' $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 //< [ 7 l r
APPLICANT NAME: /i/e/g ,s
APPLICANT ADDRESS: 27, c) `I/
SEPTIC CESSPOOL
DESCRIPTION OFF �
PROPOSED CONSTR% ION OR ALTERATION
Zfrr)-6/
-i_. /4,1-/ *
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 614" ';,e1.)t /k--ifa,t
OWNER MAILING ADDRESS: /9, r ,S'�.e v „a p--iz
� ,2x
OWNER PROPERTY ADDRESS. Sac' k-c) L3 s.___ 17 f`
JU `f N Y /D036
TELEPHONE NUMBER OF CONTACT PERSON: 76i-3.; C"---
TAX
; -TAX MAP NO. : Section /3s Block / Lot 7(
CROSS STREET: /7 eie
BUILDING PERMIT NUMBER CROSS REFERENCE:
0--44/49PI -74--1-;
Signature of Applicant
RECEIVED BY: L,u,'ct
AR cvvn Clerk's Office
DATE: ; 9 , •
..
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