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ELIZABETH A.NEVILLE e Town Hall,53095 Main Road
TOWN CLERK y = P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER :__ 4: �,• 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. 3188 R Residential x Non-Residential
Fee $ 10.00 septic x Cesspool
PERMIT ISSUED TO:
Name : GENDOT HOMES
Address 1: PO BOX 534
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-02-0008
Name Of Owner GENDOT HOMES
Mailing Address 1 PO BOX 534
City st Zip WADING RIVER NY 11792
Property Address 1 2145 OAKLAWN AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 3 lot 22.003
Cross Street WELLS ROAD
Building Permit Number Cross Reference:
Issue Date: 9/01/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ��' y� Town Hall, 53095 Main Road
TOWN CLERK y Z $ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS %%%%41. $ Southold, New York 11971
MARRIAGE OFFICER ;1'ifJ t)'/ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER /l * -tot Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,,,," southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
eta rti4 D
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 3, 2004 `} ^! ' Clerk
Transmitted herewith is a copy of application No. 3329 for a Cesspool/Septic Tank
Construction Permit submitted by:
Gendot Homes
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: oir
i
744Si ature
Dated
, . . ..
O
ELIZABETH A.NEVILLE 144, 4�` Town Hall, 53095 Main Road
TOWN CLERK ' p - P.O. Box 1179
•
REGISTRAR OF VITAL STATISTICS � yj $ Southold, New York 11971
MARRIAGE OFFICER : 1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER `�'4 * a0-le Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER RI .I, southoldtown.northfork.net
......00
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 3c,1-9
Permit No.
Applicant Name E@d - t9
Applicant Mailing Address PC ijN/ &3'i
/t) ////-5- £ AA/ // 742_
Septic Tank (/or Cesspool j,/
Brief Description of Proposed Construction or Alteration /)eO _Sp-Isirci'pi/,
Location of Proposed Construction/Alteration:
Owner of Property: fi r/ -A/0y)eq..r--
Owner Mailing Address: lad i S2 y
6uadi,y Aliip ,A/c' //moi' 2-
Owner Property Address: L<- 3 if- /ctiate.4-7 .Atea t`15
Skit//c// /191 //4i7/
Name and phone number of contact person eaiz,x_ s"; z,,r - s-
Tax Map No: Section 7 0 Block 2 Lot jd/c7)7
Cross Street If/'W5 pa,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY ITH HEALTH DEPARTMENT APPROVAL
6/3/
lb
Signature of ' , slicant Date
Received by: �'��/-��
. LOT AREA= 45,625 sq. ft.
. F.F. ELEV.= 24.5
GAR. ELEV.= 23.0 vACOOT 12
LOT Nu'" 155"
28.
21
S 36.53.40"E
------ (22.4)
U1'I OL_ .(,OJE'Y DE AIITMEN f Cr HLALT[ SERVICES I O
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PE'[M T 1:01`,,RO AL.OF CONSTRUCTION Fon A In
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SINCLL:r.?"iLY RIIGIDENCE ONLY
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APPROVE ' I �
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-3W 375.00' Tl / 20• DRAINAGE Ew9E]IOIr -
(21.8)N 2323 50"W 125.00' (21.0)
OAKLAWN AVENUE
. .ate„ -
VACANT 1
DE OFFSETS M I N JS MEEK MOWN HamN THE SANCTUM TO THE
PRO OR.LIM NE RIR A IP !WOE NO USE NO TERNEIE AN NOT JOB No. 01-617 FILE No. PECONIC DEVEL. CORP.
NINON 10 ONE M NEMA OF VENOM RENON—. ..►'oo.s.winos.
PLAIN IOM AOUmN 10 MONO'CR NTN OTHER CONSIRUCTION.
SURVEYED FOR
UNFUR4I11013 NIEIQON ORSwim TO 1111 SURVEY N A VELAMEN OF SCHEN LOT NUMBER 3
NM of THE NEIL RULE ffpE moon°"IAN MAP OF PECONIC DEVELOPMENT CORP. AT SOUTHOLD
OIINIR®@MOM HERON MILL NRI OILY m THE NINON FOR NIDI THE
NOW N NENINI.NO ON Is NMII m DE nnF CENNWC ONAMMENTAL SITUATED AT SOUTHOLD
MOM ND INNRN ISmu bl MID NINON.NO m DE ArEEm OF TIE
MONO 11101MMON-ErwwTE3 ARE NOT 1nWIFOOO E TO POOITI IAL N3TM°1°a TOWN OF SOUTHOLD — SUFFOLK COUNTY N.Y.
OR S NrE UVIT ENERS.
OOP=OF TM SLIMY NV NOT KNOW THE UM RUAVE1mrs MED SFAL OR SCALE 1' = 50' DATE 12-20-2001
ENoINIED AAL SOU NOT No MODERN 10 EE A HND TEE DOW.
FILED MAP No. DATE
CERTIFIED ONLY TO: TAX MAP No.(REF ONLY)1000-70-3—P/022 DISK 500
HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
Ftc,.. 1,0( F.--r ;2— 1866 WADING RIVER—MANOR RD. WADING RIVER,
NEW YORK, 11792
N.Y. LIC. No. 048992 631-929-4695
HAROLD F. TRANCHON JR. PENN. LIC. No.2115—E