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ELIZABETH A.NEVILLE ite_� Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS W �► �� Southold, New York 11971
MARRIAGE OFFICER :1°4,, VI
Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � "'/®1 A cif Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �,,s' 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. 3015 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 SHEARIN, JON
Mailing Address 1 2670 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 35 TRACK AVENUE
City St Zip CUTCHOGUE NY 11935 se:.
Tax Map No. section 136.00 block 2 lot 17.001
Cross Street STILLWATER
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 ��1,$ Gy� Town Hall, 53095 Main Road
TOWN CLERK d P.O. Box 1179
ti Southold
REGISTRAR OF VITAL STATISTICS A! i , New York 11971
MARRIAGE OFFICER �� Fax(631) 765-6145
RECORDS-MANAGEMENT OFFICER �y�®l ��®�i�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
9 2003OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 19, 2003
Transmitted herewith is a copy of application No. 3138 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for J Shearin
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.
Signature
V17/03
Dated
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OFFICE OF THE TOWN CLERK es
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TOWN OF SOUTHOLD s• &/�3
FT.T7ABETHA.NEWTTP,TOWN CLERK ,� O • Application No.
P.O.BOX 1179 • —__
SOUTHOLD,NEW YORK 11971 : _ Construction
v T
` Alteration
Telephone o.
%°,f�, �.7�•�,, $10.00 - Residential
(631) 765-1800 10 ��
-„,,,,, $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION . RECEIVED
for
CONSTRUCTION or ALTERATION PERMIT BAR 1 9 2003
SEPTIC TANK or CESSPOOL
Southold Town 0°0(
Permit No.
Fee .$
DATE- ,o) - 3
APPLICANT NAME: dibef f7.C:5>DO
APPLICANT ADDRESS: €' g° /E-72///966 77—
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SEPTIC CESSPOOL_
DESCRIPTION � PROPOSED CONSTRUCTION OR ALTERATION
1.�'_._! -
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR CTION 0 LTERATION•:
OWNER OF PROPERTY: CA4
OWNER MAILING ADDRESS: /,�s”-/ ecze% 42-0-19
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OWNER PROPERTY ADDRESS: '
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TELEPHONE NUMBER OF CONTACT PERSON: XI:" SYc
TAX MAP NO. : Section -/...7‘ Block 2 Lot / - /
CROSS STREET: , C77/4t)--a,&--------
BUILDING
C77//BUILDING PERMIT NUMBER CROSS REFERENCE:
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Si'gnature of Applicant
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RECEIVED BY: /
Town erk's Office
DATE: 3/I 9(cQ •
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