HomeMy WebLinkAboutGusmar Realty (3) OA,
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JUDITH T.TERRY •� _� Town Hall, 53095 Main Road
TOWN CLERK ;
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JUDITH T.TERRY � _ 'yi,�` Town Hall, 53095 Main Road
TOWN CLERK C P.O. Box 1179
,i Southold,New York 11971 _
REGISTRAR.OF VITAL STATISTICS #4) j__ �� 1•'� Fax(516) 765 1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER = ,( jig �a011� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER . s ,d°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
9
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 8, 1996
Transmitted herewith is a copy of application No. 1624 for a Cesspool/
Septic Tank Construction Permit submitted by:
Gusmar Realty •
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 c
Comments: 7C .� S&9 7 3/#' ?o��jSa—d c f
READ
OCT 11996 A
Signature
/a /6A,
Southold Town Clerk Dated
OFFICE OF THE TOWN CLERK ,•' ' 71
Town of Southold �,'''� \ LKC
._ /1-5,. , �
5 Application No.
Judith T. Terry, Town Cleric "%' �O -. Gy
Town Hall, 53095 Main Road , �t . Construction t/
P. 0. Box 1179 Alteration
Southold, New York 11971 .to
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Telephone ��O ��� $10.00 - Residential /
1
(516) 765-1801 > , ' $25.00 Non Residential
TOWN OF SOUTI-HOLD
• SOUTIIOLD WASTEWATER DISPOSAL DISTRICT
. APPt_ICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE October 7, 1996
APPLICANT NAME: Timothy Collins, AICP Agent for Gusmar Realty
APPLICANT ADDRESS: 27 Joshua Edwards Court
East Hampton, New York 11937
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Proposed
single family residence to be serviced by public utilities.
LOCATION MAP: • Must be attached hereto before permit may be issued.
LOCATION OF PRQ,POSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Gusmar Realty
OWNER MAILING ADDRESS: 13 15 37th Street
Long Island City, New York
•
OWNER PROPERTY ADDRESS: Shipyard Lane
East Marion, Southold
TELEPHONE NUMBER OF CONTACT PERSON: (5161329-5930
TAX MAP NO. ; Section 35 Block 08 Lot 5.6
CROSS STREET: Marina Lane
BUILDING PERMIT NUMBER CROSS REFERENCE:
Sig la ure of Applicant
RECEIVED BY: ` / -
Town Clerk's &ice
DATE: �° / 6 —
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
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FOR APPROVAL OF CONSTRUCTION OF �r'1( *� d- I _c
i SINGLE FAMILY RESIDENCE ONLY ,4.,`'; ur o�w-
1 DAVE -2 q H" ► ._‘1 ,- L;;:. '\ .1 V.
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APPROVED. .fir,. Z 1
EXPIRES THREE YEARS FROM DATE OF APPROVAL
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