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ELIZABETH A.NEVILLE e��,tea° Gid Town Hall, 53095 Main Road
TOWN CLERK ¢ P.O. Box 1179
v, $ Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER 0.��1�
RECORDS MANAGEMENT OFFICER � ® to.� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - �� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TA� �AF1` f
SOUTHOLD WtUD15Fl AL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2866 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SAMUELS & STEELEMAN
Address 1 : 25235 MAIN ROAD
City St Zip CUTCHOGUE NY 11935
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 #R10-02-0102
Name Of Owner MENOOZA, NEIL >; AMELIA
Mailing Address 1 FORWARD LTD
84-86 REGENT STREET
City St Zip LONDON UK 0000
Property Address 1 38015 MAIN ROAD
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 2 lot 15.001
Cross Street GREENWAY EAST
Building Permit Number Cross Reference:
Issue Date: 8/22/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �il,_OGZd% Town Hall, 53095 Main Road
TOWN CLERK 1% o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % � i Southold, New York 11971
MARRIAGE OFFICER ` 1 0*.
RECORDS
' '/Qd 0 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ,_" •®'',, Telephone(631) 765-1800
FREEDOM OF INFORMATIO FICER .0°°1 southoldtown.northfork.net
j OFFICE OF THE TOWN CLERK
1 L:a AUG _ 2002 (� TOWN OF SOUTHOLD
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TO:IC'�•+1f :;s- `,:;Soix't11ldMd-To Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 30, 2002
Transmitted herewith is a copy of application No. 2969 for a Cesspool/Septic Tank Construction
Permit submitted by:
Samuels and Steelman Architects
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
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Comments: J�J////J/�g1/,lJp4 re-_
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OFFICE OF THE TOWN CLERK I .•����/'••'•••,,��� Vf TOWN OFSOUTHOLD ,'.O��FI =. Application N
FT I7ABETH A.NEVILLE,TOWN CLERK 44%0 • y
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 : Z
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Alteration
in �•`�
Telephone ;_ ,��' Q �• $10.00 - Residential
(631) 765-1800 Ol * ,,f • $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT RECEIVED
APPLICATION JUL 2 9 2002
for
Soutkold'Town Clerk
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. .
Fee •$
DATE Qlaz.y 2?, veva
• APPLICANT NAME: tygifm0Ez.k ' TEC , aiwt—Eer-,j
APPLICANT ADDRESS:
25.7 v5/ yj'f l/�/ ID4j9
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Aier4 cS'/4/&t E fl rMiLy - occe , D /m0001 11-07)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: )i/EIL 'D :11n�Z09 iZ /002
OWNER MAILING ADDRESS: /?j 1,,,6)D -7ZD. 1I,S(v 'F6 ✓r sr`
oCQA/iO/ HAi2 6 D/) UA`
OWNER PROPERTY ADDRESS: ,gD/t 47,41, go/K,
ems/EN
TELEPHONE NUMBER OF CONTACT PERSON: 73Lo5
TAX MAP NO. : Section /5 Block 19,a Lot /5, I
CROSS STREET: 415,2 J/4 675167- 6 4—el
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
•
ignature of Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
SUFFOLIt_CANN'I DEPARTMENT OF HEALTH SERVICES ';f)/J]aps , �;;_
1 PERMIT-FOR-APPROVAL OF,CONSTRUCTION FOR A "
¢�(sial ev-ciao rixiel en-9ioi
c,-:SINGLE FAMILY RESIDENCE OW#Y I Cares� Photo Date February 22, 1999
DATE [C�t H.S Ef �I �1 _ a 'o t�)` ) N 76-44'0• C.
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FOR MAXIMUM OF C BEDROOMS f-. S ' , - E -- X4' 0 _ ...
EXPIRES THREE YEARS FROM DATE 0 APPROVAL 1-�, ` "� =,=, - :'0 11
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