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ELIZABETH A.NEVILLE �� � 'y Town Hall, 53095 Main Road
TOWN CLERK - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1 C K„ °�
Southold, New York 11971
MARRIAGE OFFICER 1%` �r � � �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = $ iii1ITelephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2845 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CREENBRIAR HOMES INC
Address 1 : 59 HAWXHURST ROAD
City St Zip COLD SPRING HARBOR NY 11724
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 #R10-01-0130
Name Of Owner CALISE, MARCO & NOEL
Mailing Address 1 14 TAJ COURT
City St Zip CENTERREACH NY 11720
Property Address 1 OLD FIELD COURT
City St Zip MATTITUCK NY 11952
Tax Map No. section 120.00 block 3 lot 8.023
Cross Street FRAMVEU ROAD
Building Permit Number Cross Reference:
Issue Date: 7/23/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A. NEVILLE t1 •4 ; Town Hall, 53095 Main Road
TOWN CLERK 1 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER # ���1�, Fax (631) 765-6145
RECORDS MANAGE F �® •„.01 Telephone Telephone (631) 765-1800
FREEDOM O �jf F( R .1 ,,�/� southoldtown.northfork.net
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j 0 200 J FFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
I f_
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 9, 2002
Transmitted herewith is a copy of application No. 2950 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Greenbriar Homes Inc. for Marco and Noel Cause
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 1.V7
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. t`,7 :4-/-4.-,9
--"7"1-(d'""V‘"' ✓*/(re
Signature
-7/., A,_.
Dated
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OFFICE OF THE TOWN CLERK ,�' c
TOWNOFSOUTHOLD / '64 IXj; Application No.
��
ELIZABETH A.NEVITI F,TOWN CLERK : . 'I'1
P.O.BOX 1179 ;. • Construction
SOUTHOLD,NEW YORK 11971 • Z T
Alteration
Telephone
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• $10.00 -Residential
(63t) 765-1800 -��1 � $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE 7/ / /02-
APPLICANT NAME: 4 A1,AQ # $$ /4'G,
APPLICANT ADDRESS,: .a4-2 , # // € 7 ,e-4�.b
eOL -5®/a/A/ f1/9,eg0, /1/)/ //.7,7-
SEPTIC
/.7,SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
eigo%i.e‘14/`7,0i1 oL 56riw_ / ,... .,....‹...<•,,004,94. A2/2
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• . OWNER OF PROPERTY: 0/97///2CO ,°�4-it' e26 /�E
OWNER MAILING ADDRESS: /' 742. c O ), -7
ee/ir��ieb. ei- , A'Y // .7,9-.0
OWNER PROPERTY ADDRESS: Ok0 iei3Of eeb1�7
g7/4.-r-r/ 77)c -- /t//
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /2t2 Block 10 Lot 69;c-.
CROSS STREET: ,j9,/i7Vci-b" ,'1q2
BUILDING PERMIT NUMBER CROSS REFERENCE:
�if,e.rs1/�,e/r #4 /9-1'.°,,,‘:-S. '_,/4
/®,tea,
Signature of Applicant
RECEIVED BY: '' , 't_ •
Tow Gf'erk's Office
DATE: 7 7 �� -
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