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ELIZABETH A.NEVILLE �� � Town Hall, 53095 Main Road
TOWN CLERK `4 P.O.Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS :% O (' Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER _�®� ,,..s�22�,, �� i��, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - `as'
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4017-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner SOUND DESIGN HOMES
Mailing Address 1 P 0 BOX 605
Mailing Address 2
_ City St Zip CALVERTON NY 11933-0000
Property Address 1 LLOYD'S LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-727-2299
Tax Map No. section 99.00 block 3 lot 4.009
Cross Street SOUND VIEW DRIVE
Issue Date: 5/12/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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OFFICELOFFICE OF THE TOWN CLERK �„F31
� FFD
TOWN OF SOUTHOLD 0� �COt Application No. 4 /7
ELIZABETH A.NEVILLE,TOWN CLERK `
� � $10.00 - Residential 6,./P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 �'�`� $25.00 - Non-Residential
: - -- Telephone 7 _ ( * '
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
- for - -
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ t® .DD
•
DATE 3( 1310
OWNER NAME: Sv urv' D-d f�1
OWNER MAILING ADDRESS: Pa 2 bk (p O S
Ca_krU e -�,r, ,P 11i 3.3
OWNER PROPERTY ADDRESS:
OWNER TELEPHONE NUMBER: —7a ') — a 9-9 6- 11o)
TAX MAP NO. : Section ° Block 3 Lot ' . 009
CROSS STREET: Sr, a U � �
TYPE OF SYSTEM: Septic Tank New Existing _
Cesspool New Existing
-
Residential -- ✓ - Non-Residential
�. a03
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
(VAI-1-10
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: -
oiestfFOLt
ELIZABETH A.NEVILLE 1� O -� ����.\` Town Hall, 53095 Main Road
TOWN CLERK - ..c P.O. Box 1179
•
ti e Southold,New York 11971
REGISTRAR OF VITAL STATISTICS >yrri
MARRIAGE OFFICER `^'` 4 1� Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER \`� ?f ON- 1 Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER l '0 .
��1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2035 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SOUND DESIGN HOMES INC
Address 1 : PO BOX 605
City St Zip CALVERTON NY 11933
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-99-0151
Name Of Owner GOLD, CAROL ANN
Mailing Address 1 5815 ROYAL LAKE CIRCLE
City St Zip BOYNTON BEACH FL 33437
Property Address 1 LLOYD'S LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 3 lot 4.009
Cross Street SOUNDVIEW DRIVE
Building Permit Number Cross Reference:
/tzt/4'
Issue Date: 3/10/99
Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)