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ELIZABETH A.NEVILLE O �0 Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Vtt,
MARRIAGE OFFICER � o ' Southold, New York 11971
Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER \� = ®� ,ss22, $4;,e.
FREEDOM
�i', Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `-s' ���
OFFICE OF THE TOWN CLERK
SOUTHOLD lACAISMHIVATERITIESBDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2578 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 SEIFERT, ALICE
Mailing Address 1 360 DOGWOOD DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 360 DOGWOOD DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 8 lot 2.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 5/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE a y� Town Hall, 53095 Main Road
TOWN CLERK y ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` Southold, New York 11971
MARRIAGE OFFICER � 1i �� ', Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �,_ ®d $.®1i."�I
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,i'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 3, 2001
Transmitted herewith is a copy of application No. 2666 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for Seifert
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,
(D
Dated
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OFFICE OF THE TOWN CLERK �1 ,/,"••• •�
S�FFotkc -: .
TOWN OF SOUTHOLD Q A lication No.
FJ I7ABETH A.NEVI)J.F,TOWN CLERK �OQ : P R.� ;.�
- P.O.BOX 1179 . Constructio - "
SOUTHOLD,NEW YORK 11971 SG Alteration
$10.00 - Residential
Telephone _�.y,� �
(631) 765-1800 O�
- O-
$25.00 -Non-Residential
TOWN OF SOUTHOLD
e •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION • ,
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$ rr
DATE 717- 7
APPLICANT NAME: _ /11.3a.0 CZ'
APPLICANT ADDRESS: 7c,) /-7/1//t/Cc)
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SEPTIC CESSPOOL'
DESCRIPTION OF,ROPOSED 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:
OWNER MAILING ADDRESS: �C0 d'9 1.000 r�
OWNER PROPERTY ADDRESS: 3(00
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Ll--Y Block g Lot 2,
CROSS STREET: •
BUILDING PERMIT NUMBER CROSS REFERENCE: •
f.j /
Signature of Applicant
RECEIVED BY: ( X-
own -rk's Office
DATE: d
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