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ELIZABETH A. NEVILLEyd` Town Hall, 53095 Main Road
TOWN CLERK H Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS `. Oy� Fax (631) 765-6145
4 ',1 Southold, New York 11971
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER Ol Alt *a•oo� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,•is" 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. 3279 R Residential X Non-Residential
Fee $ 100.00 Septic X Cesspool
PERMIT ISSUED TO:
lame : MCM HOMES INC.
Address 1: 6 CHERRY LANE
city St Zip MOUNT SINAI NY 11766
Descripton of Proposed Construction or Alteration
NEW CONSTRUCTION
FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARMENT
Name Of Owner MCM HOMES INC.
Mailing Address 1 6 CHERRY LANE
City St Zip MT. SINAI NY 11766
Property Address 1 RED FAWN ROAD
city St Zip SOUTHOLD NY 11971
";ax Map No. section 760.00 block 2 lot 706
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 2/01/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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— t ELIZABETH A. NEVILLE ��� y 4 d% Town Hall, 53095 Main Road
TOWN CLERK co
%y z ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 47 iSouthold, New York 11971
MARRIAGE OFFICER 14. 'j' 0./ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER -....."49./ *,, 4:0,0,' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER . ,,.4:0,0 southoldtown.northfork.net
Jai ` ;,2�,,,.r OFFICE OF THE TOWN CLERK
�L TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 12, 2005
Transmitted herewith is a copy of application No. 3423 for a Cesspool/Septic Tank Construction
Permit submitted by:
MCM Homes Inc
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:
-41 e,,,C, / -
Signature /24
0 /7/01–/d S—
Dated
i
���,00g11FF0�,�co,
t ELIZABETH A.NEVILLE ,���`Z`� * Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS . to At I
Southold, New York 11971
MARRIAGE OFFICER : O �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER \-7___491
y D�i��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER — ' � ilroi southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT •
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$101 or Non-Residential @$25 Application No. 3(4?N.5
Permit No.
Applicant Name 1`\i'\L iv\ k\o c.S -SAC_.
Applicant Mailing Address c, Gi . , I
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration.,4AST.
Location of Proposed Construction/Alteration:
Owner of Property: iv\C-V''\ \o k a5 C_,
Owner Mailing Address: `,, G �, LA
vV\.t. S:Ads %Atk- , c u ? 6 G
Owner Property Address: Rte. V-4•aki
,S01. 04--
Name and phone number of contact person A .-L S(i.,- 76e— i'70%
Tax Map No: /003 Section "7( Block tT . Lot 71 to
Cross Street Ao . )A 4 Vit' o A
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SVEY HE TH DEPARTMENT APPROVAL
7,1,117 ...,
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Signature of Applicant Date
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Received li
I 1 Young & Young F�NC
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LOt „ 400 Ostrander Avenue, Riverhead, New York 11901 t s
N 1 I ook At 8ayvlew 631-727-2303
� _ °Forester" ili I�
Subdivision (�/Qoant) Howard W Young, Land Surveyor g
_ X Thomas C. llolpert, Professional Engineer gal
o
I u s x o Robert C. Tast, Architect g
a 3I4.tQ s Ronald E. Pfuhl, Landscape Architect
�yrt • Ns4°56.I4811E 263.61' A Douglas E. Adams, Professional Engineer VII`
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'D _ �'��I n 'r � '� c SURVEY WAS PREPARED IN ACCORDANCE ,, +'.. ••- , =g
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S r0 T v /,/ ry HOWARD W. YOUNG, N.Y.S. L.S. NO. 458415 '' ...:.___":!..., 0 LAIWA a
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" �FF� BAYV I!V4 CLUB INC. V b r
R 0 LOT 6 "FORESTBROOK AT BAYVIEW" rEile
No o ry At Bayview, Town of Southold
x'8� N73° .,_ AR ,' mry Suffolk County, New York =P
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A' S R;�� County Tax Map District 1000 Section 7e1 Block 02 Lot -1.6 i0.-
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NOTES `Y JQ -0x / `
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AREA = 107,108 5Q. FT. O �03 SURVEY MAP COMPLETED NOV. S, 2004 a•15F
P • SUBDIVISION MAP - "FORESTBROOK AT BAYVIEW" FILED FIELD SURVEY COMPLETED NOV. 4, 2004 05
2 IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON ' 3 i.
JUNE 15, 2004 AS FILE NO. I I I I9. /7,, "= -e sD
SCALE: I 50
JOB NO. 2004-0e11 BP E€
\ p=MONUMENT SCT ■ =MONUMENT Fame Q=STAKE ser =STAKE FOUND l DWG. 2001_0145_0006_2004_Ob"II_bp 1 s t
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