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ELIZABETH A.NEVILLE Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Al i Southold, New York 11971
MARRIAGE OFFICER `= #L � �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � �Q $b��ti� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER � Dsoutholdtown.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. 3048 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 DUNBAR, DIANNE
Mailing Address 1 19 SCOTT DRIVE
City St Zip MELVILLE NY 11747
Property Address 1
615 DOGWOOD LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 37.00 block 1 lot 11.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 6/11/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ,'l`Z� Gy
Town Hall,53095 Main Road
:
TOWN CLERK o A I P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t. WV. Southold,New York 11971
MARRIAGE OFFICER ►►� Fax(631) 765-6145
• RECORDS MANAGEMENT OFFICER _y'ffp1 �a�l��� Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER -_,�, ����,��� 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: May 23, 2003
•
Transmitted herewith is a copy ofapplication No. 3172 for a Cesspool/Septic Tank ALTERATION
Permit submitted by: _
Morris Cesspool for Diane Dunbar
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.
* * * * * * * * * * * *
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 C 4
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Dated
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ELIZABETH A.NEVILLE 1��,/�°Z`® ��y�: Town Hall, 53095 Main Road
'TOWN CLERK q : % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
• -MARRIAGE OFFICER : 1� • Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ��y�J� a0-'el� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER -_,70/
'/ �' s' southoldtown.northfork.net
OFFICE O1 THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10or Non-Residential @ $25 Application No. 3/
Permit No.
0
Applicant Name /'tel C6, f , i // i 57,e _ ,
Applicant Mailing Address 2 2lod 7/-_,-///////sco r,--- /l,c
Septic Tank or Cesspool ' ,
Brief Description roposed Construction or Alteration
O v e._?�gr
Location of Proposed Construction/Alteration:
Owner of Property: OTA-`✓Ail. ,PC<–iA/-,z
Owner Mailing Address: ! i .. - /1141e/a"
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Owner Property Address: Lp (, 4),.." A9
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Name and phone number of contact person
Tax Map No: Section 7 7 Block / Lot /7
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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Signature of Applicant Date
Received by: _ Vid-rit's—i