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JUDITH T. TERRY = Town Hall, 53095 Main Road
TOWN CLERK •. v T . P.O. Box 1179
U' �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �. �� Fax (516) 765-1823
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MARRIAGE OFFICER o,k� .a) ,•' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '�-'�/ 4 . �,i'
FREEDOM OF INFORMATION OFFICER „i�OFFICE OF TH: TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1273 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 OVERFLOW 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 GOLDSMITH, ALVAH B.
Mailing Address 1 C/O BRUCE GOLDSMITH
P. O. BOX 1496
City St Zip SOUTHOLD NY 11971
Property Address 1 HOBART ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 64.00 block 3 lot 8.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 1/19/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY coec , Town Hall,53095 Main Road
TOWN CLERK k caz , P.O.Box 1179
t 0 v,t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ire, ! �1 Fax(516)765-1823
MARRIAGE OFFICER re, a0 �� Telephone 516
RECORDS MANAGEMENT OFFICER •� ) �► ��� P ( )765-1800
FREEDOM OF INFORMATION OFFICER - „„ ,,.S' f2 llW f
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OFFICE OF THE TOWN CLERK 4 Ii
TOWN OF SOUTHOLD 1,---,,---1
BLDG. DEPT.
TO: Southold Town Building Department TOWN OF SOUTHOLD
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: January 3, 1995
Transmitted herewith is a copy of application No. A1320 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Morris Cesspool Service for Alvah Goldsmith .
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:
APPROVE - EXCAVATION INSPECTION
DISAPPROVE - REQUIRED
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Date
OFFICE OF THE TOWN CLERK ,.,,""""
.Town of Southold .,'�� . DLI('('
Judith T. Terry, Town Clerk ;,'O% Ol/�: Application No./3c>74
Town Hall, 53095 Main Road Z < = Construction
P. O. Box 1179
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Southold, New York 11971 :fp' 7„ Alteration
Telephone .41kV AL' ����' $10.00 - Residential
(516) 765-1801 _--
,�����,,� ' $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 5 3 , _7.3l
APPLICANT NAME: 11_ >/ ,�, -AA:, -.4.(
APPLICANT ADDRESS: a 'C) - , ' 1 4j•
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: / ig1).�7A,¢X-
OWNER MAILING ADDRESS: O ,cue_/' C OiS'/1r/' )'�
P66 GA / /9
OWNER PROPERTY ADDRESS: __Cdccf7--44'e, /7
TELEPHONE NUMBER OF CONTACT PERSON: ( __?jc
TAX MAP NO. : Section (6-'4Y Block ,F Lot Sz-
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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pv Signature of Applicant
RECEIVED BY: RECINED
Town Clerk's Office
DATE: JAN 31995
torn Qerk Southold
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