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ELIZABETH A.NEVILLE /07 I`
Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �
MARRIAGE OFFICER
'W � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/Q ��®�i•�/ 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. 2972 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 BARNES, JOHN
Mailing Address 1 54300 ROUTE 48
City St Zip SOUTHOLD NY 11971
Property Address 1 54300 ROUTE 48
City St Zip SOUTHOLD NY 11971
Tax Map No. section 52.00 block 3 lot 1.000
Cross Street RUCH LANE
Building Permit Number Cross Reference:
Issue Date: 12/26/02 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE # Town Hall, 53095 Main Road
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TOWN CLERK t o P.O. Box 1179
2 Southold, New York 11971
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REGISTRAR OF VITAL STATISTICS V 6
MARRIAGE OFFICER �,iL � �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �__�Q! � ,i• Telephone (631) 765-1800
--FREEDOM OF-INFORM TIONNOFFICER ���� southoldtown.northfork.net
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-L6 5 2002 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
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-Tb:.v_�, Southold-Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 26, 2002
Transmitted herewith is a copy of application No. 3074 for a Cesspool/Septic Tank Construction
Permit submitted by:
Morris Cesspool for John Barnes
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: / - 1e.
Signature
/X—X7`-.Z
Dated
•
OFFICE OF THE CLERK •,
TOWN
TOWN OFSOUTHOLD
RIC V
FT.T7ABETH A NEVI E,TOWN CLERK ••' Ol/ A p p!i c t i o n N o�d 7
P.O.BOX 1179 •�
SOUTHOLD,NEW YORK 11971 Construction
• v' tinAlteration
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Tele hone _ ,f �/•�• $10.00 - Residential
(631) 765-1800 �► •
; ' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE j .< j 0
APPLICANT NAME: •
APPLICANT ADDRESS: 226;c7) �(jy. ✓ c,r
SEPTIC CESSPOO-6-4
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: d,-A,i/
OWNER MAILING ADDRESS:
S c� 'FAd
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: .6 )A .
TAX MAP NO. : Section „4-2, Block Lot (
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CROSS STREET: ?A = -�
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Applicant
RECEIVED BY: I
Town Clerk's Office
DATE: / /- 2 7-
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Town Of Southold
P.O Box 1179
Southold, NY 11971
Y * * * RECEIPT * * *
Date: 11/26/02 Receipt#: 1309
Transaction(s): Subtotal
1 Septic Permit-Construct- Resid. $10.00
Check#: 1309 Total Paid: $10.00
Name: Barnes, John E.
54300 North Road
Southold, NY 11971
Clerk ID: LINDAC Internal ID:64294