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ELIZABETH A.NEVILLE �� OG'1�; Town Hall, 53095 Main Road
TOWN CLERK o • P.O. Box 1179
Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS Prr
MARRIAGE OFFICER
:%46444_� �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER .fr�,•• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ �i southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2822 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner BOSTWICH BAY CO.
Mailing Address 1 480 GILLETTE DRIVE
City St Zip EAST MARION NY 11939
Property Address 1 480 GILLETTE DRIVE
City St Zip EAST MARION NY 11939
Tax Map No. section 38.00 block 2 lot 5.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 6/21/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ���$� y Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
Z Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS leo
MARRIAGE OFFICER �����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =,�Q1 .. Fax
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 23, 2002
Transmitted herewith is a copy of application No. 2923 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool Service
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.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
7/17, � oo
Dated
1
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OFFICE OF THE TOWN CLERK ,"
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TOWNOFSOUTHOLD .• C31€ r, � Application No. ol9)--3
ELIZABETH A.NEVI LLE,TOWN CLERK , O G
P.O.BOX 1179 O Construction
SOUTHOLD,NEW YORK 11971 =b 46G /
Alteration �/
Telephone y,jQr�' $10.00 -Residential
(631) 765-1800 "= fel Jr�,,."' $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 /(1)(4y 2 3 v 2
APPLICANT NAME: /21O2('&$
APPLICANT ADDRESS: 7 ,2 71
1o ' , /,
SEPTIC CESSPOOL
DESCRIPTION OF ROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: 'V/C� C- ///L ftp Qlrt
��f l "tie/a--J
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7`.f OCX-d
TAX MAP NO. : Section e Block 2 Lot LC-
CROSS STREET: r 25—
BUILDING
. 5—
BUILDING PERMIT NUMBER CROSS REFERENCE:
,,SDe_z_re, ?a- /72 -z,„,„ •
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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