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ELIZABETH A. NEVILLE tite
Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS '��� Southold, New York 11971
MARRIAGE OFFICER �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �___®1 `010. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ 1
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2486 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JAMES R. COX, SR.
Address 1 : PO BOX 353
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW TO EXISTING SYSTEM.
APPLICATION APPROVED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner COX, JAMES R. SR.
Mailing Address 1 PO BOX 353
City St Zip MATTITUCK NY 11952
Property Address 1 2595 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 1 .14 block 10 lot 2.200
Cross Street YOUNGS AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/29/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ��_ GZ13.1: Town Hall, 53095 Main Road
TOWN CLERK ; y 2 ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS /� Southold, New York 11971
MARRIAGE OFFICERFax
5
RECORDS MANAGEMENT OFFICER ON'
4:161.
��® .��, Telephone 5
e (631)331) 76541800
FREEDOM OF INFORMATION OFFICER •_ '' ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 15, 2000
Transmitted herewith is a copy of application No. 2574 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
James Cox Sr.
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.
Linda J. Cooper
* * * * * * * * * * * *
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
Dated
OFFICE OF THE TOWN CLERK ' fl Ux
TOWN OF SOUTHOLD ����5 BOG= Application No.7574
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 ; lO Construction
SOUTHOLD,NEW YORK 11971 v •• rn
ttAlteration
Telephone ,if' �Q �' $10.00 - Residential
(631) 765-1800 ,� $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
•
DATE la- -
01660
• APPLICANT NAME: —I SS
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APPLICANT ADDRESS: d? 5q 5- ��ST� 1 c.v
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION to Pept .E
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: // ;• S
OWNER MAILING ADDRESS: cd 35 3
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OWNER PROPERTY ADDRESS: _23-FS- Gt)0 °s � ykIfii
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TELEPHONE NUMBER OF CONTACT PERSON: 63fe oVe?=86Z-7'
TAX MAP NO. : Section /No 0-0 Block /6/00 Lot D2.2. .DOO
CROSS STREET: E
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
To‘:
RECEIVED ,BY:
Tow Clerk's Office •
DATE: / 'oZ.7/,6`r10/
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