HomeMy WebLinkAboutCase, Gerard Mir
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ELIZABETH A.NEVILLE ;+++ • OG#•
; Town Hall, 53095 Main Road
TOWN CLERK - P.O. Box 1179
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t ti Z ; Southold,New York 11971
REGISTRAR,OF VITAL STATISTICS ` Fax(631) 765-6145
MARRIAGE OFFICER
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RECORDS MANAGEMENT OFFICER � �Q -►a ,�, 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. 3232 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GERARD CASE
Address 1: 505 WEST CEDAR POINT DRIVE
City St Zip SOUTHOLD NY 11971
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 INSPECTINO REQUIRED.
Name Of Owner CASE, GERARD
Mailing Address 1 505 WEST CEDAR POINT DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 505 WEST CEDAR POINT DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 90.00 block 1 lot 7.000
Cross Street MIDWAY ROAD
Building Permit Number Cross Reference:
Issue Date: 10/01/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ',� 4` Town Hall, 53095 Main Road
TOWN CLERK tcia Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS VO .F��� Southold, New York 11971
MARRIAGE OFFICER � ��,. Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =dot * ill. so Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
....••''ro southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
SEP 2 0 21114 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 20, 2004
Transmitted herewith is a copy of application No. 3374 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Gerard Case
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
'����oi OFFO ,�c
ELIZABETH A.NEVILLE ����`t` 4)0 -'•
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Town Hall, 53095 Main Road
TOWN CLERK ' p % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , Southold, New York 11971
MARRIAGE OFFICER 0
. O V 1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER y 40*it Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER '� Alt i's, southoldtown.northfork.net
OFFICE OF THE TOWN CLERK v
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 VO--r Non-Residential @ $25 Application No.331
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Permit No.
Applicant Name C�
Applicant Mailing Address . S7' 6-0-Glire 141�
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Septic Tank or Cesspool v------
Brief
Brief Description of Proposed Construction or Alteration �1��,✓� , A./t.-
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Location of Proposed Construction/Alteration:
Owner of Property: .. ,,A9 GecQ C' c,.,.
Owner Mailing Addresse SCS L.t..) . CcLifle� P-1- (fit,
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Owner Property Address:„�-,Q,•�e"
Name and phone number of contact person,�it7e7 ��s��; %,. . // 2Y ''3�.5
Tax Map No: Section 05i:2, Block O 1_00 Lot 001.coO
Cross Street ,,��uA1 Z,
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
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Signature of Applicant Date
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Received by: V
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SURVEYED FOR:- 7/ /-/ at5QC/til4,L//CJ -
LOCATED AT 8.4 Y v/E L'v (coA7 ' 463'6.4 C.--) , TOWN OF �O UTNO L.C7 , SUFFOLK COUNTY N.Y.
LOT /3,9
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