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ELIZABETH A.NEVILLE ��,�� �'� Town Hall, 53095 Main Road
TOWN CLERK ; - P.O. Box 1179
49 Ze
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; /'��
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ��.1®1 �i6e Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 41 ��� 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. 3003 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 GALATI, SUE
Mailing Address 1 200 ROGER ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 200 ROGER ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 66.00 block 2 lot 16.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 2/18/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
:., ,, ®�UFFOo , ; 3 003
ELIZABETH A.NEVILLE 1��� Town Hall, 53095 Main Road
TOWN CLERK CO - P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS � �' �
Southold, New York 11971
MARRIAGE OFFICER
®� � ���� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = ® ®'ii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �s' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 3, 2003
Transmitted herewith is a copy of application No. 3125 for a Cesspool/Septic Tank Construction
Permit submitted by:
Morris Cesspool
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: �y' , f �.c,,<� i' ! 412,
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Signature
u)-/.03/0_3
Dated
OFFICE OF TEE TOWN CLERK ,,,;,,••••••••,,
TOWN OF SOUTHOLD ;' S�FFOtkc
FT.T7ABETHA NEVILLE,TOWNCLERK ���'�� te • Application No. C ��
P.O.BOX 1179
SOUTTHOLD,NEWYORK11971 Construction
11;v' Alteration
� '�
Telephone f �,t�• $10.00 -Residential
(631) 765-1800 '_- Kt
„��,,,,• ' $25.00 -Non-Residential
TOWN OF SOUTHOLD
e •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
•
Fee .$
DATE 3 CJ
APPLICANT NAME:
APPLICANT ADDRESS: i / i , 2Z n!eco r
SEPTIC CESSPOOL--.I
DESCRIPTION OF ROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: fd.u. 6)/41'-/� '
OWNER MAILING ADDRESS: 20-51 a
,Ce 14 t-li_efei
OWNER PROPERTY ADDRESS:
•
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block 2 i'' Lot C7 14
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
9°7/4 7(1—
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: al -?
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