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ELIZABETH A. NEVILLE $ `Z` �,; Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
y Z • Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
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MARRIAGE OFFICER `
RECORDS MANAGEMENT OFFICER ;41,*l �aO�01�' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2238 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JAMES C NEKERMAN
Address 1 : PO BOX 62
City St Zip NEW SUFFOLK NY 11956
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 #R10-99-02111
Name Of Owner NEKERMAN, ANN
Mailing Address 1 PO BOX 62
City St Zip NEW SUFFOLK NY 11956
Property Address 1 355 GRANGE ROAD
City St Zip NEW SUFFOLK NY 11956
Tax Map No. section 117.00 block 2 lot 16.000
Cross Street GRATHWOHL ROAD
Building Permit Number Cross Reference:
Issue Date: 2/08/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETII A.NE` — 1 k is AZ y Town Hall, 53095 Main Road
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TOWN CLERKp , P.O.Box 1179
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REGISTRAR OF VITAL STTICS � v� 1�` Southold, New York 11971
MARRIAGE OFFICER +o %%, 1 Fax (516) 765 6145
RECORDS MANAGEMENT OFFICER or �1�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ' ��0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 31 , 2000
Transmitted herewith is a copy of application No. 7326 for a Cesspool/
Septic Tank Construction Permit submitted by:
James Nekerman •
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
`Signatur
Dated
-111
.
OFFICE OF THE TOWN CLERK ,• �'' 0`K
TOWN OF SOUTHOLD ,�'O� COG Application No. 3,2,.c,
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 _ Z Construction
SOUTHOLD NEW YORK 11971 Alteration
Telephone $10.00 - Residential
(516) 65-1801 1 �' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE / 2 9" v,OD o
APPLICANT NAME: a g (.a► /Ye/ . '-i a)
APPLICANT ADDRESS: "O 130,x d
/Y-c err .se-- • 0/.-r
SEPTIC CESSPOOL K
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Ai - /y'
OWNER MAILING ADDRESS: /2?Q ,Z o/
/Y4 /o /. /Y,. //f
OWNER PROPERTY ADDRESS 3 r6- 'v 9 ' - Ad
G S 70, /4-
TELEPHONE NUMBER OF CONTACT PERSON: P-3 s`O
TAX MAP NO. : Section /1 7 Block o Lot / 6
CROSS STREET: 62rd" ) , p I/ ,d
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature o Applicant
RECEIVED BY:
Town erk's Office
DATE: / AT
d
TEST HOLE DATASURVEY OF PROPERTY
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