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ELIZABETH A.NEVILLE , ®G�d Town Hall, 53095 Main Road
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TOWN CLERK o - P.O. Box 1179
W Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER ����,L ���1�,
RECORDS MANAGEMENT OFFICER =___"Oi 0��®iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,��'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2782 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MORRIS CESSPOOL
Address 1 : 2760 YENNECOTT ROAD
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 WAYNE HILDENBRANDT
Mailing Address 1 2875 BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 2875 BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 1 lot 37.001
Cross Street GLEN ROAD
Building Permit Number Cross Reference:
Issue Date: 3/21/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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f ELIZABETH A.NEVILLE SII A:7 G# Town Hall, 53095 Main Road
TOWN CLERK o A ;
P.O. Box 1179
2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS s
MARRIAGE OFFICER `� ?i Fax, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER -0o��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER rrrr southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department u,
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 19, 2002
Transmitted herewith is a copy of application No. 2882or a Cesspool/Septic Tank Construction Permit
submitted by:
Morris for Wayne Hilderbrant
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
r
Comments:
Signature
3// .9/4a-
Dated
OFFICE OF THE TOWN CLERKW .�i �'��111L •,�
TON OF 1
�•4C4 tkc�G__ Application No4
Fr.T7ABETH A.NEVJT'.F,TOWN CLERK 0
P.O.BOX 1179 `
Construction !�
SOUTHOLD,NEW YORK 11971
• V) Alteration
Telephone O,f� $10.00 -Residential L�
(631) 765-1800 _D.l' t P •••
$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 n/f, /7 0 �- -
APPLICANT NAME: -01)46$ tliy�
APPLICANT ADDRESS: Zjd � ,1(-c Tr Dx
SEPTIC CESSPOOL✓
DESCRIPTION OF/ZPPRO/POSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 4/.eye */yd/rAe/Psien"
OWNER MAILING ADDRESS: g?7)"--
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7,157,7,-eab\
TAX MAP NO. : Section 7f Block Lot j27. /
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
lit-X774 51- 7frie-t; •
Signature of Applicant
RECEIVED BY:
Town CIe k's Office
DATE: j
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