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Home My WebLink AboutGallagher, Dennis & Rita s.. ELIZABETH A.NEVILLE "\0f soyo lTown Hall,53095 Main Road ,`O 0 TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER G b Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �' a� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �lif'CAU0,� 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. 3646 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : SKREZEC, STANLEY Address 1: 50 GULL POND LANE City St Zip GREENPORT NY 11944 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION REQUIRED. Name Of Owner GALLAGHER, DENNIS & RITA ------------------------------ Mailing Address 1 42 WELLS ROAD ------------------------------ ------------------------------ City St Zip GREENLAWN NY 11740 -------------------- -- ---------- Property Address 1 3140 MINEEHAHA BLVD ------------------------------ ------------------------------ City St Zip SOUTHOLD NY 11971 -------------------- -- ---------- Tax Map No. section 87.00 block 3 lot 40.000 ------ --- ------ Cross Street NOKOMOS ROAD ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 9/09/08 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) sof sorry ELIZABETH A.NEVILLE O� ®� Town Hall,53095 Main Road TOWN CLERK O P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER cr+ �r Fax(631) 765-6145 G Q RECORDS MANAGEMENT OFFICER a� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �IyCOU NTY,� southoldtown.northfork.net t,,t�, OFFICE OF THE TOWN CLERK n j TOWN OF SOUTHOLD ra '\+vr`9V 1i TQO,,,,C. �'r s� 'oufho d Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: June 6, 2008 Transmitted herewith is a copy of application No. 3807 for a Cesspool/Septic Tank ALTERATION Permit submitted by: Stanley Skrezec for Dennis and Rita Gallagher 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. Signature Dated %%SFF0(,( ELIZABETH A.NEVILLE h`Z` Gy Town Hall, 53095 Main Road TOWN CLERK p P.O.Box 1179 COD 2 Southold, New York 11971 REGISTRAR OF VITAL STATISTICS A9 MARRIAGE OFFICER O Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER y4J0 ®� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER '� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. 3;cD Permit No. Applicant Name Applicant Mailing Address Septic Tank or Cesspool_ Brief Description of Proposed Construction or Alteration AGPR,.zay% n\4 psycb�s 0,oap 10 CbAL - :1 L.-,0 C-Lv S— o � Z & , p fog--41 0'1"lkr�j Location of Proposed Construction/Alteration: Owner of Property: Dgm'�S Owner Mailing Address: L42- WQ-k�& egw o Owner Property Address: [':�f`� Name and phone number of contact person Tax Map No: Section Block `� Lot D Cross Street `Qcwp NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Signature of Applicaht Date Received by: F ELIZABETH A.NEVILLE � � �' � Town Hall, 53095 Main Road TOWN CLERK ` ' �ysi P.O.Box 1179 REGISTRAR OF VITAL STATISTICS � `r , Southold, New York 11971 ✓r MARRIAGE OFFICER Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER 1 Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF TIME TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @ $19er-Non-Residential @$25 - Application Permit No. Owner Name Owner Mailing Address [ i Vr.Le% ra eta • lea_1,.n+ i P e t a`cm----.--_ Owner Property Address Owner Telephone No. Tax Map No: S Io Cross Street �- Please check each that applies: New Construction Alte on to Existing System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) Signature of Appl'cant V Date Received b Pe-c-c> 6 c,"l Fl 0 6x:l s4 a-,L-,— Q` I - - e� � I - IQ preec4S�-