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ELIZABETH A. NEVILLE 140 ; Town Hall, 53095 Main Road
TOWN CLERK C ® R4-14 44e, P.O. Box 1179
REGISTRAR OF VITAL STATISTICSk Southold, New York 11971
® ` �� Fax (631) 765-6145-
MARRIAGE OFFICER :" �v �1
RECORDS MANAGEMENT OFFICER = �% ��� Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER ' ,ssoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2748 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 CHINNICI, MICHAEL
Mailing Address 1 12 WINTERGREEN DRIVE
City St Zip MELVILLE NY 11747
Property Address 1 1175 SANDY BEACH ROAD
City St Zip GREENPORT NY 11944
Tax Map No. section 43.00 block 4 lot 39.000
Cross Street BAY ROAD
Building Permit Number Cross Reference:
Issue Date: 2/20/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �s � 2
� f �ATown Hall, 53095 Main Road
cm - % P.O. Box 1179
TOWN CLERK t 1 t
REGISTRAR OF VITAL STATISTICS � i Southold, New York 11971
MARRIAGE OFFICER `., .� ,• ' ,* .11 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =__�®1 i%*.®�i' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER r '� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ( n�f fi� _�'-? �
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TO: Southold Town Building Department �
CEPT
FROM: Linda J. Cooper, Southold Town Clerk's Office r�''" `��� '3 r``��
DATED: February 20, 2002
Transmitted herewith is a copy of application No. 2845 for a Cesspool/Septic Tank Construction
Permit submitted by:
Morris Cesspool for Michael Chinnici
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: -
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Signature /
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Dated
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OFFICE OF THE TOWN CLERK ,' ��Ffotxc�
TOWN OF SOUTHOLD
FrWABETHA.NEVA.i.F,TOWN CLERK l‘°'' Application No 51 J
P.O.BOX 1179 �`
Construction
SOUTHOLD,NEW YORK 11971
ye Alteration
Telephone =��,f�® ►�Q�0°,, $10.00 -Residential
(631) 765-1800 - 1 0 $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 /524- 2 c) a/ Z
APPLICANT NAME: _ /-)/ 0' s' LJ�s'p a ( -
APPLICANT ADDRESS: 'Z ?‘ o �//l h/01'/�Ca 7-T P,4 _
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- - SEPTIC- - CESSPOOL-k" - - -_
DESCRIPTION OF PROPOSED 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: / 2 G0 47C-,y6-E-1,/ eX
OWNER MAILING ADDRESS: k(z /// %/i.; d y //7 '2
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OWNER PROPERTY ADDRESS: // 73-- yij-j., giA, ,t a
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 14` Block L/ Lot 3 g
CROSS STREET: J 4-y A,
BUILDING PERMIT NUMBER CROSS REFERENCE:
10-. MO-c-,-,_ ' '
Signature of Applicant
RECEIVED BY: /0/1!" -
To Clerk Office
DATE: O /( "e-') 6,e-_____
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