HomeMy WebLinkAboutGatz, Walter & Marilyn REGISTR2~R OF V/'~AL STATISTICS
MAiiRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM O ~I~.,~/~A~O~/IA_TiOlX[ OFFICER
i, OiJN - ~ ~ oFFIcE OF THE TOWN CLERK
i TOWN OF SOUTHOLD
TO: Southold Town Building.Department
Town Halt, 53095 Main Road
· "' P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southold~own.nort hi'orb net
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 2, 2004
Transmitted herewith is a copy of application No. 3325 for a Cesspool/Septic Tank Construction
P~rfit submitted by:
Walter & Marilvn Gatz
Please review the application and location map and advise if the project has received Suffolk County
Health Department app. roval 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:
Signature
ELIZABETH A. NEVILI,F,
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
}JAHRIAGE OFFICER
RECOKDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
south61dtowmnor~hforlr net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PER~HT
CESSPOOL or SEPTIC TANK
Residential ~ $10 ," or Non-Residential~$25__
Applicant Mailing Address P-~. ~:~K
Application No. ~'~
Permit No.
,,S'~Ptic Tank or Cesspool
./Brief Description of Proposed Construction or Alteration /~t~btJ hD/J7 ~
Location of Proposed Construction/Alteration:
OxwnerofProperty: LOt? Pter ¢
Owner Mailing Address: P-g). [~dX
Owner Property Address:
Name and phone number of contact person
Tax Map No: Section
Cross S~eet C~x ~e~.. £o~
· Block 03 Lot '~- ~"
NOTE: LOCATION i%{AP MUST BE SUBMITTED V~ITH APPLICATION. NEVq
· /'---d-'o_.,.S.4,cY
~ ,'~ SignaiureofA~plieant (g ](~' Date
Received by: '~/L) L~ d ~. / .
Young & Young
63!-727-2303
Thomas C. gfolpert, P~ofeas~o~al Ez~ji~eew
Robert C. Tast, Architect.
DouCas E. Adams, Profes~oaal E~gi~eer.
NOTE
A~,EA = &O2D4 AC,~ES '
5URVDr'oR'5 OERTIFIOATION
· ~ ~C~¥ G~TIF¥ TO WALTER BATZ &
MARILYN GATZ THAT THI~ 5L~.'/~¥ ~A~ P~A~ IN
A~OO~ANCE ~ITH THE CO~E OF P~AOTiC~ FO~ LAN~
~U~VEY~ A~O~TE~ 5~ ~ N~ ~0~ STATE A~IATION OF
HAL'F[R ¢,ATZ t,
H^ lL'r
At; Plc2:f. il:uck, to~n of Soul:hold
5¢folk Counf,~J, N¢~ 'r'ork
/
/
/
/
Lo~. 2
o¢ ~°~¢\\~°