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ELIZABETH A. NEVILLE ��� y� Town Hall, 53095 Main Road
TOWN CLERK t tris = P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘`‘.as
PPP �
MARRIAGE OFFICER
Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =�O1 jig 14V-060 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. 3260 R Residential X Non-Residential
Fee $ 100.00 Septic x Cesspool
PERMIT ISSUED TO:
'lame : MARTIN, TOM & DEBBIE
Address 1: 5 ADAM LANE
City St Zip WESTHAMPTON BEACH NY 11978
Descripton of Proposed Construction or Alteration
SINGLE FAMILY DETACHED HOME; 4 BEDROOM, 3 BATH, & 1/2 BATH
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner MARTIN, TOM AND DEBBIE
mailing Address 1 5 ADAM LANE
City St Zip WESTHAMPTON BEACH NY 11978
Property Address 1 LOT 25 LAUREL LINKS (SUBDIV)
City St Zip LAUREL NY 11948
Tax Map No. section 125.00 block 4 lot 24.018
Cross Street ROUTE 25
wilding Permit Number Cross Reference:
Issue Date: 1/27/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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` ELIZABETII A. NEVILLE �� � Town Hall, 53095 Main Road
TOWN CLERK H Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS O 47$
Southold, New York 11971
MARRIAGE OFFICER ' 41O• , Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _O.( lig d� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���,,,, southoldtown.northfork.net
19 2W4 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 18, 2004
Transmitted herewith is a copy of application No. 3403 for a Cesspool/Septic Tank Construction
Permit submitted by:
Tom & Debbie Martin
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: •
•
c/4‘644
Signature
2dA4
Dated
.
,°,�o��SOFFO�,��;�
`
• ELIZABETH A.NEVIL YN,, Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 17, i
MARRIAGE OFFICER : O '� 1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =�,L V I�� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER =701 * a1 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @$25 Application No.3 14 r7
Permit No.
Applicant Name 1M o-,nck
Applicant Mailing Address S Astouok LYN • 7
bJes-k4wkkAP h c , OJ 1 R $
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration S,.ns\ Co-.um,\n dls
`na�u2_ ; ca( 3- 94 &_yzb ,
Location of Proposed Construction/Alteration:
Owner of Property: � eb+�
Owner Mailing Address: P►d owvk Ln
Owner Property Address: Lo4- 2- L—r-1 (.t rt vic s vtoal.Lv t s t
Name and phone number of contact person \' e c)c e, Ro.(��n -Z g S
Tax Map No: 101 l'2 Section Block id Lot 14 . 1 S
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
iA kin/ Old
Signature of Applicant Date
Received by: Q4. JJ '
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Map ofLot25 — - - - - - -
"Map of Laurel Links"
Filed: November 23, 2001, Map Number 10712 •iu J
Situated at MattitucktO
Town of Southold, Suffolk County, New York Q
District 1000 Section 125 Block 4 Lot 24.18 `It
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iL -1A7,11,11',. k Z C ON FOR A frwo/vi i/GEIS /77.9/0
G, 2f, 7-. , NC ONLY
,k1-3_' 4 1:1-7.(_)- 2,77, :7 1.0 o�l•r1►oma
III Y?_'o ED \ _.. YE Y _ ,n
FOR.?,-,L4::::=2.:1: -.773.C.0MS
EXPIRES SIMM Y-ARS h TMr. . °.: PROVAL 1 ANTHONY ABRUZZO R.L.S.
___ _____-- REGISTERED LAND SURVEYOR
1500 Hortons Lane
- ••_ Southold, New York 11971
a'4 ,9 i,-, (631)-209-0676
r.> SURVEYED: March 27, 2004
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ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 sx_
OF THE NEW YORK STATE EDUCATION LAW.COPIES.OF THIS SURVEY MAP NOT $'',
BEARING THE LAND SURVEYOR'S ORIGINAL SIGNATURE AND INKED OR EMBOSSED Nib ''��,` /
SEAL SHALL NOT BE CONSIDERED A VALID TRUE COPY.
THIS PARCEL IS SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. - '"''''"'8�, — File
ELEVATIONS REFER TO AN ASSUMED DATUM. " " Scale: 1" — 30 File No. 2733
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