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ELIZABETH A.NEVILLE ,�� *A‘ • Town Hall, 53095 Main Road
TOWN CLERK ; 2 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER " 4* ����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =__ 91 *„10. Telephone Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER • 1r��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2504 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SANDRA SAVAGE
Address 1 : 548 EXPRESS DRIVE S., STE 202
City St Zip RONKONKOMA NY 11779
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 # R10-00-0233
Name Of Owner HEINZ, PETER
Mailing Address 1 17 MARVIN AVENUE
City St Zip HICKSVILLE NY 11851
Property Address 1 NORTH LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 15 lot 10.000
Cross Street WEST LANE
Building Permit Number Cross Reference:
Issue Date: 2/06/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
1Rig: -77 T-FT: ca5-61 .
OF FOLit
ELIZABETH,A.NEVI �,I� "Os 1••= Town Hall, 53095 Main Road
TOWN CLERK �.___� i N P.O. Box 1179
REGISTRAR OF VITAL STATISTICS;s j;q 3�s" ; '�� Southold, New York 11971
MARRIAGE,OFFICER"^" °""" # `. Fax (631) 765-6145
RECORDS MANAGEMENT OFFICERI Telephone (631) 765-1800
41
FREEDOM OF INFORMATION OFFICER _ i"
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, 2001
Transmitted herewith is a copy of application No. 2592 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Peter Heinz
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.
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Dated
•
OFFICE OF THE TOWN CLERK '''G���OLKG
.T7TOWN OF SOUTHOLD �� QGy; Application No.c` S
FiABETH A.NEVILLE,TOWN CLERK � t
P.O.BOX 1179 Construction v
SOUTHOLD,NEW YORK 11971v rn ;
N Alteration
•Telephone ,j,� ��Q�;i�, $10.00 - Residential
(631) 765-1800 1 > ,.0' $25.00 -Non-Residential
,,.,,,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE (k4
APPLICANT NAME: I) 0_10 1446 6a,U
APPLICANT ADDRESS: add /LQ,Th
r-ri
SEPTIC \/ CESSPOOLS.
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION .1),(c)(9042c_c-g
`�flti CJ a l/fit. Oznprl( 6ti-- ej/k.r y(J<1-05r----
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: ii 11.0-1 -!(1 NAL.-
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OWNER PROPERTY ADDRESS: - /V 6,e711 4.19N e-
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ?f Block 15 Lot /U SSU
sp
CROSS STREET: tU,SLS I `r pL_�__�
BUILDING PERMIT NUMBER CROSS REFERENCE:
i
effr -rlf -'of Applic- t
RECEIVED BY:
Town CI rk's Office
DATE: /- 3/- 0(
SUFFOLK COUNTYYDEPARTMENT OF HEALTH SERVICES
1
J PERMIT
SINGLEFORAPPROVAL FAMILY RESIDENCEOFCONSTRUCTION ONLY FOR A
01 ,
• . DATE rO 2,4-00H.S. REF. No. \D `'v0 - as33_
APPROVED
"L4 FOR MAdIMUM OF
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EXPIRES THREE YEARS FROM DATE Of APPROVAL
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