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ELIZABETH A. NEVILLE �/ d Town Hall, 53095 Main Road
TOWN CLERK ; ita
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t Southold, New York 11971
MARRIAGE OFFICER \� �t, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = v��� ss22, 4P ,� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `Lr �91d
OFFICE OF THE TOWN CLERK
SOUTHOLD rWASIIIEWASKORIMEDISIDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2600 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CRAIG M ARM
Address 1 : 1675 JOCKEY CREEK DRIVE
City St Zip SOUTHOLD NY 11971
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 #R10-00-0285
Name Of Owner ARM, CRAIG M
Mailing Address 1 1675 JOCKEY CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 7000 BAY AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 5 lot 9.000
Cross Street BROADWATERS ROAD
Building Permit Number Cross Reference:
Issue Date: 6/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
oFF04 0?60°
ELIZABETH A. NEVILLE i -' Hall,
, _% •ley; Town 53095 Main Road
TOWN CLERK ; '_; P.O. Box 1179
New York 11971
REGISTRAR,OF VITAL STATISTICS ` c%.* � � r: � � % Southold,
MARRIAGE OFFICER :®�s ,': 1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER -_ /4 �
__ �r� ��YG,,,4'i.%1°,`,10� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER Vis'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 1, 2001
Transmitted herewith is a copy of application No. 2688 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Craig M. Arm
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
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Dated
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OFFICE OF THE TOWN CLERK �''t;��FfOLk��-_
TOWN OF SOUTHOLD .� Application No. /($
Rt.T7ABETH A.NEVILLE,TOWN CLERK o `
P.O.BOX 1179 . Construction
SOUTHOLD,NEW YORK 11971 v • T
Alteration
Tele hone •
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(631) 765-1800 l $10.00 -Residential (1,„„* '� $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
1ST
DATE jc,1,,rE , 2.CC
APPLICANT NAME: _ Cig pttL.t
APPLICANT ADDRESS: ICo78- dGY
�r�uTi-co�tJ, p_i`d 11971
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Sn tC9LC FA✓''•11-`r 12-C%t S't_'-LGi
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C LLC IM, M2-A",
OWNER MAILING ADDRESS: Po 6076. 17.5H
Som--toLD, 1,44 I I°111
OWNER PROPERTY ADDRESS: 70oc- i ' ,.(e)-1,,6: ( cu&. LA
GLaTc-k-iacaue. t �� 11.°►35''
TELEPHONE NUMBER OF CONTACT PERSON: C031' '7,caS - LBGE
TAX MAP NO. : Section 10L-1 Block C55 Lot 0°)
CROSS STREET: '9-3-E. 25 4P•'fl\P-IA�t s AeO
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: E 5
Tow Clerk's Office
DATE: ( /( n J
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,J' CG AIM' X#1,/;1#C,vo/loy PLEASE NOTE
zo w It is the a
2i5 of �,t�o�.v �,voy applicant's responsibility to
maintain adequate sanitary distance
xodE,9404/4/fivo; between all water supply and sewage
z;werp 49410 disposal facilities.
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
W/97ez,/,v.oyce.drouv v
F,r.IfrTo/11rop/ 1.9.110 PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE FAMILY RESIDENCE ONLY
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D r= ba3b% RS ,REF/90.
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/7 AP�ROVBD L _x
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Fen MAXIMUM OF V BEDROOMS
v EXPIRES THREE'YEARS,FROM DATE OF AP- -.OVAL
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