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ELIZABETH A.NEVILLE ��� C9' ; Town Hall, 53095 Main Road
TOWN CLERK ; 4:2
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v' Southold, New York 11971
MARRIAGE OFFICER :®�,ot, �� �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER "`/® .. ,�•jig Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - �
OFFICE OF THE TOWN CLERK
SOUTHOLDN J JIQ4JQSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2688 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOOT DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.AMILY DWELLING.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENTMENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.\
EXCAVATION INSPECTION REQUIRED.
Name Of Owner TIRADO, L.
Mailing Address 1 3850 NASSAU POINT ROAD•
I'
City St Zip CUTCHOGUE NY 11935
Property Address 1 3850 NASSAU POINT ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 111 .00 block 8 lot 1 .000 I,
Cross Street WUNNEWETA ROAD
Building Permit Number Cross Reference:
Issue Date: 11/19/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
HVE
`@° 2001
ELIZABETH A.NEVILLE �� ,�' � % Hall, 5309, ,r.iA, 'oad
TOWN CLERK ; 14' BLIV ;, °:NO
REGISTRAR OF VITAL STATISTICStbj, !i 4?. • 1
MARRIAGE OFFICER % C5 '" ) Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ���`` ®��I
®� �� 1i Telephone (631) 7 -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: November 2, 2001
Transmitted herewith is a copy of application No. 2781 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for L. Tirado
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
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:
' OFFICE OF THE TOWN CLERK ,. ���9 0l`C . y
TOWN OF SOUTHOLD ., A O'- �/
,�' Application No.a
FT.i7ABETH A.NEVIT.I F,TOWN CLERK i
P.O.BOX 1179 % ; ' Construction
SOUTHOLD,NEW YORK 11971 = • ` r=te ; �/
• in - Alteration
Telephone o,�'�0 ®�0', • $10.00 -Residential `�—
(631) 765-1800 _ 1 '��
.0' $25.00 -Non-Residential
TOWN OF SOUTHOLD
e •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE 724-oz or
APPLICANT NAME: _ 42.ed /.46-1C C.: Spasi
7,:-.404cd APPLICANT ADDRESS: 70 rr P4(
i76‘c-o44 o/, J V'
SEPTIC CESSPOOL i' •
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Crsr)`e--cert
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: , /, 1-11(1 o
OWNER MAILING ADDRESS: J 7O /1//f-1(419- ,/- /e I'
OWNER PROPERTY ADDRESS: Z 6, /Ge,( /`
TELEPHONE NUMBER OF CONTACT PERSON: , X5.-
/ Y,Fe-d
TAX MAP NO. : Section /// Block e Lot
•
CROSS STREET: U,vy Ef,_,s
BUILDING PERMIT NUMBER CROSS REFERENCE:
- Fi I- /71-0-1 -
Signature of Applicant
'T PrElvED
RECEIVED BY: •
ff`ry n 2,2-ddr Office
DATE:
�encoa i -virri Clerk
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