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Town Hall, 53095 Main Road
X41 y0 P.O. Box 1179
, o Southold, New York 11971
JUDITH T.TERRY %, 1 - TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1596 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ELE DEVELOPMENT CORP.
Address 1 : P. O. BOX 1143
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. SCHD REF. #R10-97-0017
Name Of Owner ELE DEVELOPMENT CORP.
Mailing Address 1 P. O. BOX 1143
City St Zip CUTCHOGUE NY 11935
Property Address 1 GABRIELLA COURT
City St Zip MATTITUCK NY 11952
Tax Map No. section 108.00 block 4 lot 7.054
Cross Street ELIJAH'S LANE
Building Permit Number Cross Reference:
Issue Date: 3/19/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
%SUFFOL,�c
JUDITH T.TERRY �I_ 'f1 Town Hall, 53095 Main Road
TOWN CLERK y Z ; P.O. Box 1179
% ,� Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS `0 y �4�1 Fax(516) 765-1823
MARRIAGE OFFICER 4 ,1
RECORDS MANAGEMENT OFFICER �I1111Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,••���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 25, 1997
Transmitted herewith is a copy of application No. 1683 for a Cesspool/
Septic Tank Construction Permit submitted by:
E L E Development Corp.
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
MAR 1 9 1997 Signature r..?/:///'1,7,
Dated
OFFICE 01= l |IE TOWN CLERK
OLA-
Town of Southold
Judith T . Terry, Town Clerk Application No
Town Hall, 53095 Main Road Construction ^~'^
P. 0. Box 1179 ' *-$ AlieraUon
Southold, New York 11971
—
� `&x� � Res|�enda| r
Telephone � -���- "'
(516) 765-1801
765-l8O1 Nnn-Res|denUa|
-------'
TOWN AFSOUTU0LD
G[)UTUOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
-______--_'~_
APPLICANT NAK4E: ��`-*���-��
_-_- e4e,--_-___-_-____-__-__-
APPLICANT ADDRESS:
- __ __--_--'_'y__
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_ ��~"-_-��� �'^_�---_-_-_-_____-_____-_- -___-_---__-----__ -'
SEPTIC CESSPOOL
-----
DESCRIPTION OF 0F PROPOSED CONSTRUCTION OR ALTERATION
---------'----'------'
_--_--�L_������?�_--_-____-___--
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----------'---------------------'--------------------'--'-------- '--'----------'
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY :
___ 57/9/9/2;_
OWNER MAILING ADDRESS:
----------------------'------------ -----'------
OWNER PROPERTY ADDRESS:
- ----
TELEPHONE NUMBER OF CONTACT PERB0N :
--'___.-_-
TAX MAP NO. : Section /OrBlock--_05iLo/
CROSS STREET : f 1/94.0.-
BUILDING PERMIT NUMBER CROSS REFERENCE :
---�-- Applicant -------'
RECEIVED BY :
--'-----in-\Cleric's
Office
------
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