HomeMy WebLinkAboutGendot Homes (3) •
•
•
,
ELIZABETH A. NEVILLE �1h0� Ol0 Town Hall, 53095 Main Road
TOWN CLERK * * , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER �Qg�1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone (631) 765-18001
FREEDOM OF INFORMATION OFFICER I�C�U �, 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. 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 HSS
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 Number Cross Reference:
issue Date: 5/18/05 Elizabeth A. Neville
Southold Town Clerk
•
(TOWN SEAL)
fl'oty
ELIZABETH A.NEVILLE ~� Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
REGISTRAR,OF VITAL STATISTICS �O i17$
Southold, New York 11971
MARRIAGE OFFICER `y� aft'0 1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER % 411E �► ,,iFax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER -_,.,,..�' � southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 Application No. 41 a ZJ
Permit No.
Owner Name G.eAld tof' / 'ri
Owner Mailing Address 00 0 53u
Lo /tip 2ryJ/ 79L
Owner Property Address of 3 3 o
59 c-114-49/c,
Owner Telephone No. q �/ 10
Tax Map No: Section 70 Block 3 Lot 0?42, 1 Z
Cross Street L K-titc k L1
Please check each that applies: New Construction
Alteration to Existing System
Residential Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance . feet from system to building
and closest road. New construction may submit copy of survey.,•th SCHD approval.)
Signatur: p.licant Date
Received by:
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 08/25/05 Receipt#: 3916
Transaction(s): Reference Subtotal
1 1 Septic Permit-Operation - Resid. 4292 $10.00
Check#: 3916 Total Paid: $10.00
Name: Gendot, Homes
P. O. Box 534
Wading River, NY 11792
Clerk ID: LINDAC Internal ID:4292