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ELIZABETH A. NEVILLE /� , Town Hall, 53095 Main Road
TOWN CLERK ` y - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER `‘ ,iL ��il�1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER '*O j • ,�iO Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER 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. 2842 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PAMELA MILITELLO
Address 1 : 522 SOUTH 8TH STREET
City St Zip LINDHURST NY 11757
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 #R10-02-0075
Name Of Owner OLSEN, DAVID & PAMELA
Mailing Address 1 11 FROST VALLEY DRIVE
City St Zip PATCHOUGE NY 0000
Property Address 1 LAUREL LINKS
City St Zip LAUREL NY 11948
Tax Map No. section 125.00 block 4 lot 24.012
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 7/23/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
6 J^ I•1°1 OFFOUr gy2®.
11 � OI/
ELIZABETH A.NEVILLE 1 = 'y Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
Southold,
REGISTRAR OF VITAL STATISTICS v'
New York 11971
MARRIAGE OFFICER ?, � ���� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � Ql Jig *toll Telephone (631) 765-1800
FREEDOM OF INFORMAT)DN-OFFICER ,�'� southoldtown.northfork.net
•
OFFICE OF THE TOWN CLERK
,JUN 2 1 ?Ci 2 ; TOWN OF SOUTHOLD
TO: '6uthold-Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 26, 2002
Transmitted herewith is a copy of application No. 2945 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Savannah Homes for David and Pamela Olsen
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.////ped,e,66 iegrpo
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Signature
. alp 1-8/02--
Dated
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OFFICE OF THE TOWN CLERK 11r'r r rte,."„''•,���
TOWN OF SOUTHOLD ,II'%C3FFO�KcoG• Application No.O?% q�
ELIZABETH A NEVILLE,TOWN CLERK . Q t 1
P.O.BOX 1179 .` .G ; Construction .:_./
SOUTHOLD,NEW YORK 11971 v T .
• 1$1 $ Alteration
Telephone Dij'�Y �QCi� $10.00 - Residential
(516) 765-1801 _ti �,o' $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 6 ' (Q6 " ,(/0DQ
APPLICANT NAME: PQLNne,1 A k c \ I 'ie_-` \v (5 Pc-) 06,.lo N 8c\--f
APPLICANT ADDRESS: .Z. Z E , 5S
\itc MeAr\h0v_ . L, Luk " c, 1 --r s-- 7
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
5000 sy cl— COL-0A) /A � 4-001p....4-001p....
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: f A-\/0 j nf_D -P14-e£oi. A 0 kSV
OWNER MAILING ADDRESS: I / 4 C�; v� fg? •
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OWNER PROPERTY ADDRESS: (/ (
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TELEPHONE NUMBER OF CONTACT PERSON: 42] , a,,/Ii cza 414/
TAX MAP NO. : Section f c ( Block 0 (- Lot 2 7 - / 1--°
CROSS STREET: 32:3�
BUILDING PERMIT NUMBER CROSS REFERENCE:
QA i/\i,N
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Signatur- of Applicant
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RECEIVED BY: i �, �,Q�
T wn-Cierk's Office
DATE: ;2 6 0 2
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„0 'GUARANTEES OR CERTIFICA1IOIS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED,&ON THEIR BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY&LENDING DISTIIUHON LISTED HEREON
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"MAP OF LAUREL LINKS"
SITUATED AT
1 LAUREL, TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK g
m 4000 , z
a / AM, FAMILIAR WITH THE STANDARDS 41_ N
FOR, APPROVAL AND CONSTRUCTION OF ) U 4
SUBSURFACE SEWAGE DISPOSAL SYSTEMS
z Cillijr-stopher Henn, L.S.
I FOR SINGLE FAMILY RESIDENCES AND WILL c� 46 Hunting Hill Drive
• ABIDE BY THE CONDITIONS SET FORTH THERIN ` Dix Hills, NY 11746 ;
NAND ON THE PERMIT TO CONSTRUCT. , ° ' N N.Y.S. LIC. NO. 49857 0
DAVID W. OLSEN DATE 1/22/2002 X
LAND SURVEYORS (C) COPYRIGHT i
MAP NO. 10712 FILED 11/23/2001 (631) 858-1675 SCDHS GRADING PLAN
Fax 858-1676 3/16/2002
TAX MAP DESIGNATION 1000-125-04-024. 12
REF.NO. 7781 REF.NO. 7781