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ELIZABETH A.NEVILLE ,�1,/may° 'y\? Town Hall, 53095 Main Road
TOWN CLERK o - P.O.Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �` t% Fax(631) 765-6145
MARRIAGE OFFICER %Oy `. �1
RECORDS MANAGEMENT OFFICER
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FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
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. 2889 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 MOFFAT, JOHN
Mailing Address 1 48125 NORTH ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 48125 NORTH ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 2 lot 11 .000
Cross Street OLD NORTH ROAD
Building Permit Number Cross Reference:,
Issue Date: 9/24/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE i_ yd‘ Town Hall, 53095 Main Road
TOWN CLERK o - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS %A00 7 i Southold, New York 11971
MARRIAGE OFFICER : ®,L �, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER \-ywel �a®el Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER���,,, southoldtown.northfork.net
OFFICE OF THE TOWN CLERK i 1 f--,-) --
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TOWN OF SOUTHOLD I p!s ! it ;
iULI: SEP 232002 '}_.�
TO: Southold Town Building DepartmentL- FI;DG �F�9- --
7)1'1f'1 Q; 3''J I SOLD
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 24, 2002
Transmitted herewith is a copy of application No. 3018 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for John Moffat Estate
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. .
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Signature
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Dated
OFFICE OF THE TOWN CLERK ',.1/�Ffa�` ��
• TOWN OF SOUTHOLD �.' �l
FT.i7ABETHA.NEWT IF,TOWN CLERK
`ko Cfr Application No.
P.O.BOX 1179 L
SOUTHOLD,NEW YORK 11971
►� Construction
car) yc Alteration
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Telephone ;:oy�f' �ir ' . $10.00 -Residential ,-�
(63-1) 765-1800 =-.' t Of
$25.00 -Non-Residential
TOWN OF SOUTHOLD •
I,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 2 I/ 0 Z
APPLICANT NAME: _ p •rD f '('.S .ic >, ,
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APPLICANT ADDRESS: 7770 Y/ - lifca rr,ve(
SEPTIC CESSPOOL-7/
DESCRIPTIONOF 'P POSED CONSTRUCTION OR ALTERATION '
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: .
• OWNER OF PROPERTY: tY6h 7 4il4f 7U �� ���"w 6j
OWNER MAILING ADDRESS: ��"��
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OWNER PROPERTY ADDRESS: 5/) E
TELEPHONE NUMBER OF CONTACT PERSON: 7 $' .7Y1
TAX MAP NO. : Section 1/4.55- Block 0t— Lot l
CROSS STREET: .1/ I' a •
BUILDING PERMIT NUMBER CROSS REFERENCE:
.0141 frifrt-:-- . , .
Signature of Applicant
RECEIVED BY:k
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Town lerk's Office
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DATE: -z- 'o �� •
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