HomeMy WebLinkAboutBayberry Ent ELIZABETH A. NEVILLE � al.% V: Town Hall, 53095 Main Road
TOWN CLERK ` y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS '�� Southold, New York 11971
MARRIAGE OFFICER �‘ �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �_�®� "itt„ i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2525 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : BAYBERRY ENTERPRISES
Address 1 : PO BOX 119
City St Zip PECONIC NY 11958
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 #R10-01-0056
Name Of Owner BAYBERRY ENTERPRISES
Mailing Address 1 PO BOX 119
City St Zip PECONIC NY 11958
Property Address 1 MAIN STREET
City St Zip GREENPORT NY 11944
Tax Map No. section 41 .00 block 1 lot 13.000
Cross Street CHAMPLIN PLACE
Building Permit Number Cross Reference:
Issue Date: 3/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
**411-44.
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o,#01 OFFOLt
ELIZABETH A.NEVILLE tt6 ee
?'�: Town Hall, 53095 Main Road
TOWN CLERK ; H 2 . P.O. Box 1179
REGISTRAR OF VITAL STATISTICS . rry �t Southold, New York 11971
MARRIAGE OFFICER �\ .foL ��00
Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER %.:11� .�®•,• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 9, 2001
Transmitted herewith is a copy of application No. 2613 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Bayberry Enterprises
Please review the application and location map and advise jf the project has received Suffolk County
Health Depaituient 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: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
/Signature
(.3/i t)
Dated
OFFICE OF THE TOWN CLERK sC���FO(� . �
TOWN OF SOUTHOLD ,� 0� Com!/ Application No.0/ A
i.IZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 � $25.00 - Non-Residential
Telephone N * y1eor
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
COCO MC
/ 41)
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE i g`0'
OWNER NAME: 1 `IesF'`1' arreR-P' 5E5
OWNER MAILING ADDRESS: ""r` I/cf
NIL N` I I gsg
OWNER PROPERTY ADDRESS: /low
&REV POS
OWNER TELEPHONE NUMBER: -749S- 4175-
, TAX MAP NO. : Section y/ Block / Lot G�
CROSS STREET: CM/OLIN PLACE—
TYPE OF SYSTEM: Septic Tank ✓ New Existing
Cesspool New Existing
Residential Non-Residential
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.)
1,k
/
/ / / 1
Signature of Applicant
RECEIVED BY: k
Town Jerk's Office
DATE: 3799/0(
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:OLKi t,."1JNT\' F'wl"ARTMCid f 47 HErAL`44 $i- VICEL,
:RMIT F .APPROVAL OF CONSTRUCTION FOR A
SIN4E FAMILY RESIDENCE ONLY
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