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ELIZABETH A.NEVILLE _� * Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V' t
MARRIAGE OFFICER 4n4.
��, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 'frf01 , iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ii" southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3042 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ARTCO CESSPOOL & DRAINAGE
Address 1: 4225 BRIDGE LANE
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner HALSEY, CYNTHIA
Mailing Address 1 50 OAKLAWN AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 50 OAKLAWN AVENUE
City St zip SOUTHOLD NY 11971
Tax Map No. section 63.00 block 6 lot 10.000
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 6/11/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �" ' ' * \ Town Hall, 53095 Main Road
TOWN CLERK % o P.O.Box 1179
% V, Z ' Southold, New York 11971
REGISTRAROF VITAL STATISTICS `.°O V S
MARRIAGE OFFICER 1�
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RECORDS MANAGEMENT OFFICER y749l `1��,/'lTel
Fax(631) 765-6145
ei ephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
iviAY 19 2003 TOWN OF SOUTHOLD
`-TO:`-- " Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 19, 2003
Transmitted herewith is a copy of application No. 3166 for a Cesspool/Septic Tank ALTERATION
Permit submitted by: -
ARTCO Cesspool for Cynthia B. Halsey
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.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE V , .
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
7-/-4-4-7-,4
Signature
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Dated /
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ELIZABETH A.NEVILLE ��a`Z° OA_
ym Town Hall, 53095 Main Road
TOWN CLERK r4 P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
� Fax(631) 765-6145
' • • MARRIAGE OFFICER • - � - • • •
RECORDS MANAGEMENT OFFICER =y�f � '�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - '` * 1'�,.� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 or Non-Residential @ $25 Application No. "/
Permit No.
Applicant Name o ��ss ✓��'�/�i2��-�
Applicant Mailing Address yz - ��//e
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
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Location of Proposed Construction/Alteration:
Owner of Property: ,
- Owner Mailing Address:
//7 7/
Owner Property Address:S, �,�
Name and phone number of contact person 44//.///&4 ,5/6 -57.0_371.371
Tax Map No: Section 7000 Block 0b3 Lot 6 - /0
Cross_Street 2y 0,45-
NOTE:
?SNOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
Signature of Applicant Date
, 17
Received by: l� .37i P/0
"r Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 05/19/03 Receipt#: 0
Transaction(s): Subtotal
1 Septic Permit- Construct- Resid. $10.00
Cash Total Paid: $10.00
Name: Artco, Cesspool & Drain Service
4225 Bridge Lane
Cutchogue, NY 11935
Clerk ID: LINDAC Internal ID:75158
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