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ELIZABETH A.NEVILLE e #� Town Hall, 53095 Main Road
TOWN CLERK % a ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICERFax�I, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ,ss22, v`�iTelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `zs ��,,
OFFICE OF THE TOWN CLERK
SOUTHOLD IACASTEMASCBRTEECEMISAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2563 R - Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ERIC NOVICK
Address 1 : 25 HERKIMER STREET
City St Zip NEW HYDE PARK NY 11040
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 #R10-01-0085
Name Of Owner NOVICK, ERIC W
Mailing Address 1 25 HERKIMER STREET
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City St Zip NEW HYDE PARK NY 11040
Property Address 1 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 4 lot 27.000
Cross Street FIRE ROAD 10
Building Permit Number Cross Reference:
Issue Date: 5/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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5670
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APR #11 0464
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ELIZABETH A.`NEVILLE � ���� Town Hall, 53095 Main Road
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TOWN CLERK='" -_ Y� ® ', _ a , P.O. Box 1179
REGISTRAR OF VITAL #Vril $ Southold, New York 11971
MARRIAGE OFFICER \f#4 •V 0 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � ®� ss22 % le Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 0.9
...
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 24, 2001
Transmitted herewith is a copy of application No. 2653 for a Cesspool/Septic Tank Construction
Permit submitted by:
Eric Novick
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:
'gnature
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Dated
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OFFICE OF THE TOWN CLERK - ,�'COr , ; t y
TOWN OF SOUTHOLD lie
JCQGy; Application No�J �d✓FT T7ABETH A.NEVILLE,TOWN CLERKP.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 =v • T
Alteration
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Telephone t. �i• $10.00 - Residential
Ar.. (631) '7654600 =-�®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. - ' 1.1
Fee $ c046.4 1�*9
DATE t —�L� — u/
APPLICANT NAME: A✓_/�r9 vz
APPLICANT ADDRESS: f({c'kbtr 4c / —k ./'y/-J
SEPTIC .CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION ..,,,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 't - frt el,"/Ot e
OWNER MAILING ADDRESS: .see
OWNER PROPERTY ADDRESS: i-t. xcI. Z---4-37— ,--if,-627,1/
TELEPHONE NUMBER OF CONTACT PERSON: r•--
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TAX MAP NO. : Section BlockLot /000 .3/- V'',07
CROSS STREET: P;,c peJ %D
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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SUFFOLK GOI(NTY TAX # \� 295 AT1000-51-4-2-1
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