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ELIZABETH A.NEVILLE �4d: Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
'PtREGISTRAR OF VITAL STATISTICS ��,, Southold, New York 11971
MARRIAGE OFFICER �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_�®� *�®10i� 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. 2516 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DBM CO.
Address 1 : PO BOX 2100
City St Zip GREENPORT NY 11944
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 #R10-00-
Name Of Owner DBM CO
Mailing Address 1 PO BOX 2100
City St Zip GREENPORT NY 11944
Property Address 1 1105 KAYLEIGHS WAY
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 3 lot 5.004
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 2/21/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
F01
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ELIZABETH A.NEVILLE ���� °��: Town Hall, 53095 Main Road
TOWN CLERK % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Pril Southold, New York 11971
MARRIAGE OFFICER /�s ��� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_ ®` 11'11; •,i 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: February 16, 2001
Transmitted herewith is a copy of application No. 2604 for a Cesspool/Septic Tank Construction
Permit submitted by:
DBM Co
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:
ignature
tel / /0 /o /
Dated
4
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OFFICE OF THE TOWN CLERK•
l,�i',I „II.,,,,��''
TOWN OF SOUtHOLD ,41 46
�F°[KcW Application No...2 GO V
ELIZABETH A.NEVILLE,TOWN CLERK o .
P.O.BOX 1179 c/
Construction
SOUTHOLD,NI!"W YORK 11971 : v ' rn ; Alteration
Telephone 1.2.51„., ���l't $10.00 - Residential
(516) 765-1801 �l > ��,�' $25.00 -Non-Residential
' ,...// 0-',,..//
TOWN OF SOUTHOLD
SOUT LD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATEL) 1l 2.4e/
r
APPLICANT NAME:--'/Y-6 (76
APPLICANT ADDRESS: / - ,,3 ZCnv
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SEPTIC ✓ CESSPOOLtV
DESCRIPTION OF 'ROPOSED CONSTRUCTION OR ALTERATION
%/ 1 // ,0 // ' / iiP-/2. .e/ I Gli-A-,_ ,,,/ele-ei,e-,1-e/,.7
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /311e-O
OWNER MAILING ADDRESS: /Q v pie_ �C60
e- 7-6/Pdie77 Al //i
OWNER PROPERTY ADDRESS: //t5 L,, // - / ,ig '
TELEPHONE NUMBER OF CONTACT PERSON: / ` •
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TAX MAP NO. : Secti n 2Z- Block Lot
CROSS STREET: /% u
BUILDING PERMI/NUMBER CROSS REFERENCE:
R / 4 ,
Sig atu• o ' .--f .
RECEIVED BY: IL- /ajt"-----
wn Clerk's Office
DATE: a1 w Q/
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