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ELIZABETH A.NEVILLE dl�� '' " ° ' G�� Town Hall, 53095 Main Road
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TOWN CLERK . ® k> Y' L4f, t P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER ` ® ® " 1�, Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER �� �®�i�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2553 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 OVERFL TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner COOK, DONNA
Mailing Address 1 69000 MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 69000 MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 6 lot 8.000
Cross Street PRIVATE ROAD
Building Permit Number Cross Reference:
Issue Date: 4/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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`� •" / ����®Q APR 9 6 2001 i-LL'; 5
ELIZABETH A.NEVILLE �� � „ �.-- _�,,J,own Hall, 53095 Main Road
• r'er €,. e P.O. Box 1179
TOWN CLERK � • r 't•��, '•r err s., _�,�..
REGISTRAR OF VITAL STATISTICS 'Southold, New York 11971
MARRIAGE OFFICER � � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ,sZ �� �'I Telephone (631) 765-1800
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: April 11, 2001
Transmitted herewith is a copy of application No. 2641 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for Donna Cook
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.
52:r
Signature
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Dated
•
OFFICE OF THE TOWN CLERK " El1x�'
TOWN OF SOUTHOLD �� 'J Q = Application No. ' 47"
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOR 1179 Construction
SOUTHOLD,NEW YORK 11971 v • rn
A r Alteration
Telephone Q�•�••, $10.00 - Residential
(631.) 765-1800 =�01, *� $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE j A // a l
APPLICANT NAME: ' . ilie)KJ`
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APPLICANT ADDRESS: 7Y ) 1E/tJ/l4C6 'r r
SEPTIC CESSPOOL
DESCRIPTION OF P- 'P•SED CONSTRUCTION OR ALTERATION
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: J2//2/n L o Z<
OWNER MAILING AQORES$: ‘14:03GV i41 , i5IyA.•u.J
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OWNER PROPERTY ADDRESS;
TELEPHONE NUMBER OF CONTACT PERSON: ws--_,uci----e)
TAX MAP NO. : Section 7? Block Lot •
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
/c7-/ ,
RECEIVED BY:
own Clerk's •• fice
DATE: �/
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