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EZABETH A.NEVILLE ,���-
LIGy Town Hall, 53095 Main Road
TOWN CLERK ` P.O. Box 1179
�, n� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �®d 'totip Telephone (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. 2887 N Residential Non-Residential X
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HOMES ANEW I
Address 1 : 120 PLANT AVENUE
City St Zip HAUPPAUGE NY 11788
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 #C10-02-0001
Name Of Owner HOMES ANEW I
Mailing Address 1 120 PLANT AVENUE
City St Zip HAUPPAUGE NY 11788
Property Address 1 9625 MAIN BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 3 lot 23.001
Cross Street JACOBS LANE
Building Permit Number Cross Reference:
Issue Date: 9/24/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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• ELIZABETH A.NEVILLE /°• ' ‘` SEP 2 3 20( own Hall, 53095 Main Road
TOWN CLERK % co% 4 P.O. Box 1179
%REGISTRAR OF VITAL STATISTICS
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~-- 7 --Southold New York 11971
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MARRIAGE OFFICER ,y d TO1'1`,O ,_(-, i:; ,L0 Fax 631) 765-6145
RECORDS MANAGEMENT OFFICER �,_�ol �a` �i�` �� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �������� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 19, 2002
Transmitted herewith is a copy of application No. 3014 for a Cesspool/Septic Tank Construction
Permit submitted by:
•
Homes Anew I
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: --e-0-4- - /7. c4e.c..
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Signature /
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Dated
OFFICE OF THE TOWN CLERK �•�
TOWN OF SOUTHOLD '� K�.
gvFFUL ' _
FTJ7ABETHA NEWT 1.F,TOWN CLERK •'•0� Application No. ��
P.O.BOX 1179
Construction
SOUTHOLD,NEW YORK 11971 z
O
CP Alteration
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,f �Q •,• $10.00 -Residential /
Telephone
(631) 765-1800 - Ol ;" • $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
floomes AvTE
CW' 0-2-
APPLICANT
ZAPPLICANT NAME: 4-'012---S %r
APPLICANT ADDRESS: 9f - 0/6P4i-/ tkt3V Rat
SEPTIC / CESSPOOL /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
(a3Sr6/6447CDP f-rljbi.
Yrs
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: � M 2-5 ) T,
OWNER MAILING ADDRESS: 17,0 f ()LAW\-- �
HO-fl' z pc/
OWNER PROPERTY ADDRESS: t2T(e) ,' rvviNm`- (,ebi KM)
Oaftt/lot-sa pi(
TELEPHONE NUMBER OF CONTACT PERSON: 'i 2 r o0
TAX MAP NO. : Section 5348-
Block 42 Lot 1 J
CROSS STREET: SJ ! X S COPE --
BUILDING PERMIT NUMBER CROSS REFERENCE: At
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Signaturfl',:f Applicant
RECEIVED BY: %_' k.
own Clerk's Office
DATE:
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