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0004
ELIZABETH A. NEVILLE �1 Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER % ��1, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \�®� * 0i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER •I
OFFICE OF THE TOWN CLERK
SOUTHOLD IICAV3/171131720G3WEECEILEDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2589 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : VALERIE KRAMER
Address 1 : PO BOX 1360
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 #R10-00-0141
Name Of Owner KRAMER, VALERIE
Mailing Address 1 PO BOX 1360
City St Zip SOUTHOLD NY 11971
Property Address 1 980 MANHANSET AVENUE
City St Zip GREENPORT NY 1191111
Tax Map No. section 311.00 block 5 lot 20.000
Cross Street CHAMPLIN PLACE
Building Permit Number Cross Reference:
Issue Date: 5/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
01" rP
4 oli SgNighl. .)(_)
ELIZABETH A.NEVILLE �� #� Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS °vg
g',� Southold, New York 11971
MARRIAGE OFFICER : �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER % ��. 'i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,l"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 4, 2001
a6-1-7
Transmitted herewith is a copy of application No. 44110 for a Cesspool/Septic Tank Construction
Permit submitted by:
Valerie Kramer
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:
0
/Signature
Dated
77í&w CL/1e
OFFICE OF THE TOWN CLERK , • ``cC /�
TOWN OF SOUTHOLD •• O\44FI D�f�CQI/ Application No.
ELIZABETH A.NEVILLE,TOWN CLERK t y
P.O.BOX 1179 FO Construction
SOUTHOLD,NEW YORK 11971 Z
• in • Alteration
Telephone = O �Q��' $10.00 - Residential
(516) 765-1801 ' 0l �,,r' $25.00 - Non-Residential
...,,,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE
APPLICANT NAME: - \JQ )eri e t-ra yr Pr
APPLICANT ADDRESS: id 60x ) 36,0
SOuLco/(J 1Vr, I l q it
SEPTIC CESSPOOL
DESCRIPTION OF) PROPOSED CONSTRUCTION OR ALTERATION
; 1e I v/y AUC1 O vi VOcc¢n rj / -i
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: \)�, rt e erC{y2vi!
OWNER MAILING ADDRESS: 0. ekix. 136o
Soc,41,zoid fli• y. JIQ7 /
OWNER PROPERTY ADDRESS: . • i,� �..� g 9, /27Q c' : ;:,
crcQn por I
TELEPHONE NUMBER OF CONTACT PERSON: ,f/‘ - S-123 .5-
TAX
TAX MAP NO. : Section ( 3 'f Block Lot 2 O
CROSS STREET: � j� p1,2/11
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: / 1
4-,(--'(7--1---Le„..e
Town Clerk's Offic
DATE: 67//�(
, ' . ' - •-.., : ' .
, . .F...
. . . . , : '"•4,. , , ..›.' . „ . , .
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am FamMar, -withthe STANDARDS FOR APPROVAL
ND -CONSTRUC-TION OF SUBSURFACE SEWAGE .
SURVEY
ISPOSAL SYSTEMS EOR_ SINGLE FAMILY RESIDENCES i OF PIA OP EI?TY ,
nd will abide by the conditions set forth thereino.noi AT GREENPORT
n the permit to construtt, .
i TOWN OF SOUTHOLD . -
'he location of wells and cesspools shown hereon are
rom 'field observations and or data obtained from others. ( SUFFOLK COUNTY, NEW YORK
,
Jevations are referenced to N.G,V.D• 1000-34-05-20 - -
t • 11
' SCALE: 1' 30
i.,SUFFOLK COUNTY, .,,,DEPARTMENT OF HEALTH SERVICES FEB. 6, -2000
,
.... ,
. „ MAR. 20, 2000 (13.0.H. Info. )
,., pErearr FOR AP I-,',..,zoi.VAL OF CONSTRUCTION FOR A I
GL FAMILY RES OT,NCE ONLY
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EXPIRES THREE YEARS FROM DATE OF APPROVAL . .c. ‘ ..1.-- ,
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