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ELIZABETH A. NEVILLE ,64° � Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
Fax(631) 765-6145
MARRIAGE OFFICER '.�4.6c . s
RECORDS MANAGEMENT OFFICER -7014% Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER » Q ,��
OFFICE OF THE TOWN CLERK
SOUTHOLD ritUirciNkYtoeTEREDMINSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2689 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 DOWNEY, BRIAN
Mailing Address 1 1160 MAIN ROAD
City St Zip EAST MARION NY 11939
Property Address 1 1160 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 14 lot 1 .000
Cross Street STAR ROAD
Building Permit Number Cross Reference:
Issue Date: 11/19/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE
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TOWN CLERK el® p •
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REGISTRAR OF VITAL STATISTICS � ,
1� Southold, New Yolk 11971
MARRIAGE OFFICER ofr =ry t/ Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER N._ ••• Telephone Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER " ," „„ n
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OFFICE OF THE TOWN CLERK VVV"`
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 2, 2001
Transmitted herewith is a copy of application No. 2782 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for Bryan Downey
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
//AA/
Dated
•
OFFICE OF THE TOWN CLERK .•1'•c�vF% ULi-' 7��
TOWN OF SOUTHOLD ® Qy • Application No.
FTJ7ABETH A.NEVI LE,TOWN CLERK o
P.O.BOX 1179 .; ' Construction
SOUTHOLD,NEW YORK 11971 G ' T
• V) Alteration
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$10.00 - Residential
Telephone 0t°�
(63]:) 765-1800 = l *�,.�" $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
•
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE A6, 0 ff D l
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APPLICANT NAME: /C'<S X('
APPLICANT ADDRESS: 7‘6) ��C�
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATIONS-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: ,��' ) /1 6c-ri £ "
OWNER MAILING ADDRESS: //C 71/,j'/E)
77.1tie 16't
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 7/ Block ( r• Lot
CROSS STREET: _frM-� /eQQ
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature
Signature of Applicant
RECEIVED BY: * ' EIVED
Town Clerk's Office
DATE: NOV 2 2001
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