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ELIZABETH A. NEVILLE / 0; Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Q '�t Southold, New York 11971
MARRIAGE OFFICER : 1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �_��7//� is-17 $'%;"� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - `-s �/'
OFFICE OF THE TOWN CLERK
SOUTHOLD 'WMITI EIRITEtS OSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2661 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 CLARKE, JACK
Mailing Address 1 1865 YOUNGS AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 1865 YOUNGS AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 60.00 block 1 lot 3.000
Cross Street HUMMEL AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/25/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ts��� �� R �
Town Hall, 53095 Main Road
TOWN CLERK ; ` "kp P.O. Box 1179
Cia
REGISTRAR OF VITAL STATISTICS 0' �
Southold, New York 11971
MARRIAGE OFFICER :
C' -2 Y ���� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �®l 1*'i,.° Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ' �i�
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 19, 2001
Transmitted herewith is a copy of application No. 2751 for a Cesspool/Septic Tank Construction
Permit submitted by:
Morris Cesspool for John Clarke
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 locat. map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
/ Lj
Signature
11,
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Dated
OFFICE OF TSE TOWN CLERK • "�FFOLIr�'
TOWN OF SOUTHOLD �.Q�J QG Application No.
F.T7ABETH A.NEVILLE,TOWN CLERK O.
P.O.BOX 1179 • Construction
SOUTHOLD,NEW YORK 11971 p •
• to Alteration
`.
Telephone ,jj' �r;i� • $10.00 -Residential
(631) 765-1800 - 1 ��,��' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE S1C270 F 6• 1
APPLICANT NAME: _ /12/04 ,'s CUd-e
APPLICANT ADDRESS: 6 6 y__Aiiii5lec).
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9G *.*
SEPTIC CESSPOOL Z/
DESCRIPT ON OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: ,7004C �� c71 '
OWNER PROPERTY ADDRESS: /,f 6r �Owvf/ 41 E
mac.-74oP
TELEPHONE NUMBER OF CONTACT PERSON: V T 3306
TAX MAP NO. : Section /a Block / Lot 3
CROSS STREET: `'AfLt 4, /
BUILDING PERMIT NUMBER CROSS REFERENCE:
pi/9 721-0, - .
Signature of Applicant
RECEIVED BY: 41/j /
Town Clerk's Offic-
DATE: /`•//. 1' /'
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