HomeMy WebLinkAboutGendot Homes (2) SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3300 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 SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-04-0099
Name Of Owner GENDOT HCI'1ES
Mailing Address 1 PO BOX 534
City St Zip WADING RIVER NY 11792
Property Address 1 2330 WELLS ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 3 lot 22.012
Cross Street JERNICK LANE
Building Permit Nimnber Cross Reference:
y::ssue Date: 5/18/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE • �4lQ N Town Hall, 53095 Main Road
) TOWN CLERK * *, P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % N Southold, New York 11971
MARRIAGE OFFICER �Q��1��
1Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER .y1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER = COUNT(AO southoldtown.northfork.net
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,i t� ' OFFICE OF THE TOWN CLERK
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TO: •So'u'fl'1oJ Town 3uilding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 14, 2005
Transmitted herewith is a copy of application No. 3443 for a Cesspool/Septic Tank Construction
Permit submitted by:
Gendot Homes Inc
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: l/ 4"4'y / i16114111.+
7/...;(4.4445:26//4
Signature
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Dated
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suFFo�,�e _ `
ELIZABETH A.NEVII.LE ��e r`t`e 4 : Town Hall, 53095 Main Road
TOWN CLERK i 2 . ; P.O.Box 1179
ate
REGISTRAR,OF VITAL STATISTICS : N, t� Southold, New York 11971
MARRIAGE OFFICER : G '� 1% Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y Ov'��'� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� �a,'i 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 Nom(1
43
Permit No.
Applicant Name &ir?dO-
mes-
Applicant Mailing Address / 83 X 575 c '
4/ . ' 7 • itv?r/ fly / / ?
Septic Tank v or Cesspool
Brief Description of Proposed Construction or Alteration /bac) M11!/6-f�Yj-,
Location of Proposed Construction/Alteration:� /
Owner of Property: dt' /ra
Owner Mailing Address: rD /3Ji .5-.3(/'
f4) aa2fls / Ay //2 '1_
Owner Property Address: /Avvf- /2- 4/4.0 kc/. 562J/AO(c/
Name and phone number of contact person j j . i-fric kil"). 63/-722 2 2 i2
Tax Map No: ic)--)0 Section 7 J Block 3 Lot eo 2 -2-
Cross Street 1?/7/(_ _ 4 L
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WI HE ' DEPARTMENT APPROVAL
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Signature of A ' an Date
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Received by:
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