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ELIZABETH A.NEVILLE 4'0 'y Town Hall, 53095 Main Road
TOWN CLERK k o P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® � Fax(631) 765-6145
MARRIAGE OFFICER ,L
RECORDS MANAGEMENT OFFICER -_ `14®���,, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
OFFICE OF THETOWNCLERK
SOUTHOLD WAS WATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2918 N Residential Non-Residential X
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 PEARSON, NANCY
Mailing Address 1 1050 YOUNGS AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 1050 YOUNGS AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 61 .00 block 2 lot 16.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 10/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE /0 Town Hall, 53095 Main Road
TOWN CLERK % 0 - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % rrf i Southold, New York 11971
MARRIAGE OFFICER ' ,L Fax (631) 765-6145
RECORDS MANAGEMENT_OFFICER `--__ (IIaiii 10:0el Telephone (631) 765-1800
FREEDO F--T, FC�RI4ATION,OFFICER ���� southoldtown.northfork.net
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`J�_+2O2002 ,I`....a OFFICE OF THE TOWN CLERK
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�C� TOWNOF SOUTHOLD
TO: - Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 10, 2002
Transmitted herewith is a copy of application No. NR3037 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Morris Cesspool for Nancy Pearson
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
A2/2-/'z_
Dated
OFFICE OF THE TOWN CLERK '',,,���.....����.
TOWN OF SOUTHOLD ',��,oS�FF��kcoe=. Application No. a-
V.
ELIZABETH A.NEVA ,TOWN CLERK l Q Vy _.�
P.O BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 ; o T
•
• csl Alteration
Telephone 0,� �4 ,..i $10.00 - Residential
(631) 765-1800 = 01 �'�
$25.00 -Non-Residential/
TOWN OF SOUTHOLD
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. .
Fee $
DATE bC c �-
APPLICANT NAME: /1Z40124 r% V.// ,` /
APPLICANT ADDRESS: ) /fr*/17EC 0 r /
---X-ac-4-1S
SEPTIC CESSPOOL
DESCRIPTION O�F� PROO.SED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 72120-9/ �ff%,dAJ
OWNER MAILING ADDRESS: /(L O OC)? O-Ve
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 3 ,7,?0-C)
TAX MAP NO. : Section (f Block 2, Lot /,‘
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CROSS STREET: OI)/
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BUILDING PERMIT NUMBER CROSS REFERENCE:
6 /5Z/11
/ Signature of Applicant
RECEIVED BY: Ai ` 0 /
o 1, Clerk's Office
//
DATE: 9
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