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ELIZABETH A.NEVILLE Town Hall,53095 Main Road
TOWN CLERK _ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘146.‘&_
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Southold,New York 11971
MARRIAGE OFFICER ‘& � ���, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER __�Ql ���iii 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. 3099 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.
EXCAVIATION INSPECTINO REQUIRED.
Name Of Owner CARPENTER, PAT
Mailing Address 1 PO BOX 137
City St Zip SOUTHOLD NY 11971
Property Address 1 235 ORCHARD ROAD
' City St zip SOUTHOLD NY 11971
Tax Map No. section 66.00 block 2 lot 21.000
cross street
Building Permit Number Cross Reference:
Issue Date: 10/20/03 Elizabeth A. Neville
Southold Town clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE 10 4\ Town Hall, 53095 Main Road
TOWN CLERKo P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold,New York 11971
MARRIAGE OFFICER O *. 0 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y o��,•� Telephone;(631) 765-1800
FREEDOM OF INFORMATION OFFICER _ �°� southoldtown.northfork.net
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r ( ';''OFFICE OF THE TOWN CLERK -
`\ ' - inn, ` a TOWN OF SOUTHOLD
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TO: -. .Southold'Towir uilding Department
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FROM: �� Linda J. Cooper, Southold Town Clerk's Office
DATED: September 26, 2003,
Transmitted herewith is a copy/ofapplication No. 3237 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for Patrick Carpenter
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 lo 'on 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.
''21/144'.4"
Signature 4/�°
Dated
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ELIZABETH A.NEVILLE ,��j ®lea`
Town Hall, 53095 Main Road
TOWN CLERK % ea - % P.O. Box 1179
k h a $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �y. Si
MARRIAGE OFFICER : O Fax(631) 765-6145
=RECORDS MANAGEMENT OFFICER y�� .0' o' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER -- 4 1 * 11" southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION J
CONSTRUCTION or ALTERATION PERMIT J
CESSPOOL or SEPTIC TANK
Residential @ $10- - " r Non-Residential @$25 Application No. •'')1`3 7
Permit No.
Applicant Name /12O g/5 ea--5j;')er4
Applicant Mailing Address 2YeD �/vifC6 rt De\
t
Septic Tank or Cesspool ...(
Brief Description of Proposed Construction or Alteration
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Location of Proposed Construction/ terattion:
Owner of Property: / -7L C/4-6(3 7- ,,,L.,
Owner Mailing Address: 2,3(i- ✓'P
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Owner Property Address: �C/ aeO )• ( /9
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Name and phone number of contact person 76 S - 33 c c .41 be '6-
Tax Map No: Section ‘E Block 2 Lot 2/
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SUR WITH HEALTH DEPARTMENT APPROVAL
/44-741-1-‘.-
Signature of Applicant Date
Received by: � � --
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