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ELIZABETH A.NEVILLEt/ Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER : ���� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � �®� ,ss22, �� iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ED ���
OFFICE OF THE TOWN CLERK
SOUTHOLD '1AISH1rEWSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2569 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDWARD DART
Address 1 : MAIN BAYVIEW ROAD
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 #R10-00-0273
Name Of Owner ALIE DART ASSET MANAGEMENT
Mailing Address 1 PO BOX 1
City St Zip PECONIC NY 11958
Property Address 1 MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 1 lot 10.001
Cross Street GRANGE ROAD
Building Permit Number Cross Reference:
Issue Date: 5/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ���,Z .......;
� ; Town Hall, 53095 Main Road
TOWN CLERK ; ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % i Southold,New York 11971
MARRIAGE OFFICER ��-�o n � �1',
Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ;_$®� '4 ��®••� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER P ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 26, 2001
Transmitted herewith is a copy of application No. 2660 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Edward Dart for Alice Dart Asset Management Trust
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. .
Ynature
41314(3 (
Dated
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WFICE OF THE TOWN CLERK s• cc
TOWNOFSOUTHOLD Application No. ,,,2 66o
FT T7ABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 6.44
!. ; Construction
SOUTHOLD,NEW YORK 11971 vT
ct1 • Alteration
Telephone D,y • $10.00 -Residential
(631) 765-1800 -=_�- •
¶ ,�" $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$ )
DATE LI/2 4°70/
APPLICANT NAME: FA(AMie- (6412-1
APPLICANT ADDRESS: 11/1(1.64 1/16fAil (1
SOS I�� 1\41h [ 01 /
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
N VI(I.GIi Si YI-S I,Q T-6044SI (L(/vt L�
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR .CTION OR ALTERATION: •
OWNER OF PROPERTY: A4t, 1., ' - h,r T v/ttSf
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OWNER MAILING ADDRESS: 6/0 �i ({/�
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OWNER PROPERTY ADDRESS: /
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TELEPHONE NUMBER OF CONTACT PERSON: (3V- 7Z1.-
TAX MAP NO. : Section Y Block 0 ( Lot 16 o ' •
CROSS STREET: (fl(Q ,(
BUILDING PERMIT NUMBER CROSS REFERENCE:
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RECEIVED BY:
T wn Clerk's Office
DATE: (a /v/
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322.83• PERMIT FOR APPROVAL OF CONSTRUCTION FORA
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