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ELIZABETH A.NEVILLE �t��� ?°d. Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS +�% Southold, New York 11971
MARRIAGE OFFICER �� yj•••_,
�1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =,�®1 -0„.•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. 2523 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SAMUELS & STEELMAN ARCHITECTS
Address 1 : 25235 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
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 #R10-95-0035
Name Of Owner KILBRIDE, DAVID & KATHLEEN
Mailing Address 1 560 CARTER STREET
City St Zip NEW CANAAN CT 6840
Property Address 1 9045 NASSAU POINT ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 118.00 block 4 lot 14.001
Cross Street CLEARWATER LANE
Building Permit Number Cross Reference:
Issue Date: 3/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE e T�: Town Hall, 53095 Main Road
* TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �s � 1�, Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER ®,1 �� ie" 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 8, 2001
Transmitted herewith is a copy of application No. 2611 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Samuels & Steelman for David & Kathleen Kilbride
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: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
ignature
Dated
`3/()D
i
OF CE OF THE TOWN CLERK Ili c.001.406--,
TOWN OF SOUTHOLD 0. % G Application No.02C, ��
Fi d7ABETH A.NEVH LF,TOWN CLERK
P.O.BOX 1179 , Construction
SOUTHOLD,NEW YORK 11971 ,1o T Z
Alteration
Telephone Ivo, �Ori� $10.00 -Residential
(631) 765-1800 , 0/ i /�, $25.00 -Non-Residential
-- --"I,,'
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT •
SEPTIC TANK or CESSPOOL
Permit No.
•
Fee .$
DATE 3 - 0 -0 1 7
APPLICANT NAME: $QQWt ai& -Fs( e'er{I/r'L(, / vi 'S
APPLICANT ADDRESS: 25 3S Ma,l lad
Ccrke5. , f )L /1 Q3c---
SEPTICCESSPOOL
DESCRIP ION OF PROPOSED CONSTRUCTION OR ALTERATION
100,(A) p..,e.sictai4 Q._sL__
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Juin •1- 7- ( �l' i b}1(( 9 •
OWNER MAILING ADDRESS: &L O s-�—
N€l,ri C ah ea v4 CT 010eV 6
OWNER PROPERTY ADDRESS: 96 T s IAV a..5C2Lc., 6- ,'2e
TELEPHONE NUMBER OF CONTACT PERSON: 7 / 2S '
TAX MAP NO. : Section 1 i g Block d(1 Lot /41, I
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Q /ke4 - j-0i,J01 -
Signature of Applicant
RECEIVED BY: Vj e_61-l ! �
Town Clerk's Office
DATE: 3j r)
'ED ca 1 Th'Lte,J 5 AiZ5Rio�
=RTyi L o c,ei 0 AT /i/AS5Q J PD/NT 61.7,oLL i4O.)
' pf Sou71-ioL0 eze,q/RW47ER La. The water supply, and sewage disposal systems for
• this residence will conform to the standards of John Baryl:ski
,L/ eociNT/ A./ W yo/4ik' / (oT 61) the Suffolk County Department of Health Services. PO Box 1 302
f0,(2/93 = 09325Ac - B idgehampton i NY 11932
(516) 7-7944
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