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ELIZABETH A.NEVILLE �; Town Hall, 53095 Main Road
TOWN CLERK o . P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS r
MARRIAGE OFFICER ` 1i ����� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �__ ! Ali #0 11 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER of southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3013 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 CON, ANTHONY
Mailing Address 1 2575 OAKLAWN AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 2575 OAKLAWN AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 3 lot 23.000
Cross Street WELLS AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/17/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
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- ELIZABETH A.NEVILLE ����`Z` 4`� Town Hall, 53095 Main Road
TOWN CLERK % p • % P.O.Box 1179
ti Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � �Y 47$
�
MARRIAGE OFFICER
:16 4 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER L y�® 0.i Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER = '1 Alp
��*to el southoldtown.northfork.net
; =_� `', OFFICE OF THE TOWN CLERK
" ? TOWN OF SOUTHOLD
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TO: Southold Town Building Department
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-^FROM:=-_"__-Linda J. Cooper, Southold Town Clerk's Office
- DATED: March 11, 2003
Transmitted herewith is a copy of application No. 3136 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for Anthony Coniglio
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: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED
."-' 1".€1' ,, --alevee.a- --. .r-7-c-es,-4e-c•e.n,
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Signature
Dated-`J- (_/
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OFFICE OF THE TOWN CLERK ���, ,•••••,,,�
TOWN OF SOUTHOLD ,';'oc,�1FFOCir
Rr.rrABETH A.NEVILLE,Town CLERK IApplication N o t3aG
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 Construction
O T
���' Alteration
Telephone _ err••
$10.00 - Residential r�
(639:) 765-1800 ��,� r�.
, $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT MAR 1 1 2003
SEPTIC TANK or CESSPOOL
Southold Town Clerk
Permit No.
Fee '$
DATE 112 /1 d ,3
i
APPLICANT NAME: _ 2�Of iQrS ( 5"$ 0( A's/e
APPLICANT ADDRESS: 7C4 \ i�/�� �X
A.c6�`r
SEPTIC CESSPOOL—I
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 AL ERATION:
OWNER OF PROPERTY: 144 cam
OWNER MAILING ADDRESS: , 75 D,9/f/, ,.,A/A Ak
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7b.)---- nd6
TAX MAP NO. : Section ,70 Block Lot 2
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
cS-34 f5L /74,-/'"' •
Signature of Applicant
RECEIVED BY: e
own Clerk's Office
DATE:
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