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ELIZABETH A.NEVILLE ® Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR OF VITAL STATISTICSei' PPVSouthold, New York 11971
MARRIAGE OFFICER `� � 0 ���, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �®i . too Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - '�
OFFICE OF THE TOWN CLERK
SOUTHOLD rfitArcypergcfratrESAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2701 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDGEWATER II LLC
Address 1 : 126 EAST MAIN STREET
City St Zip BAYSHORE NY 11706
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 #R10-01-0011
Name Of Owner EDGEWATER II LLC
Mailing Address 1 C/O IRA HASPEL
126 EAST MAIN STREET
City St Zip BAYSHORE NY 11706
Property Address 1 63735 COUNTY ROAD 48
City St Zip GREENPORT NY 11944
Tax Map No. section 40.00 block 1 lot 20.002
Cross Street MOORES LANE
Building Permit Number Cross Reference:
Issue Date: 11/19/01 Elizabeth A. Neville
Southold Town Clerk
1
(TOWN SEAL)
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ELIZABETH A.NEVILLE O, OGy� Town Hall, 53095 Main Road
TOWN CLERK � o= P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,` Southold, New York 11971
MARRIAGE OFFICER O 47$ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER L#4t �O• ••1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER Vel southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department NOVA 16 2fq
FROM: Linda J. Cooper, Southold Town Clerk's Office •
BLDG D}-PT
JN OFSOUTHOLD '.r
DATED: November 16, 2001
Transmitted herewith is a copy of application No. 2795 for a Cesspool/Septic Tank Construction
Permit submitted by:
Edgewater II LLC
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: V-1001-13...".‘
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Signature
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Dated
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• OFFICE OF THE TOWN CLERKFU e
TOWN OF SOUTHOLD ��•. O�j Application No.
ELIZABETH A.NEVILLE,TOWN CLERK �� • ; ' N $10.00 - Residential
•
P.O.BOX 1179 ;...- •
SOUTHOLD,NEW YORK 11971 ' "' T �• $25.00 - Non-Residential
Telephone l ,
(516) 765-1801
TOWN OF SOUTHOLD -
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
AAA APPLICATION �..
' for - 9IECE-IVSD •
PERMIT NOV 16 2001
SEPTIC TANK or CESSPOOL
'Operation Permit No. . V
Fee $ •
DATE I Vida (
OWNER NAME: t✓cl y,u l _-
OWNER MAILING ADDRESS: cIo. t.v� t{�SP�.Q 1Zu 6 vita.ky% Sj
ShOr't, N. 1 I1'lol�
OWNER PROPERTY ADDRESS: la asp Coui}b (41(
• OWNER TELEPHONE NUMBER: (oat - 1491or--
TAX MAP NO. : Section q.t. Block I Lot 2-0 , 2-
CROSS
CROSS STREET: �J7
TYPE OF SYSTEM: Septic Tank X New X. Existing
Cesspool k New k Existing
Residential 1C.. Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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S'gna re of Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
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