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ELIZABETH A. NEVILLE ���= 1• Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ; g ,$ Southold, New York 11971
MARRIAGE OFFICER ‘4*
4 Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER _'"Ol jig 11b—ie
� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ i �
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2426 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JAMES FITZGERALD JR
Address 1 : PO BOX 617
City St Zip CUTCHOGUE NY 11935
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 #R10-00-0200
Name Of Owner MANOS, WILLIAM
Mailing Address 1 40-20 221ST STREET
City St Zip BAYSIDE NY 11361
Property Address 1 12035 SOUNDIVEW AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 54.00 block 5 lot 46.001
Cross Street HORTON LANE
Building Permit Number Cross Reference:
Issue Date: 10/10/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE : Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
REGISTRAR OF VITAL STATISTICSSouthold, New York 11971
MARRIAGE OFFICER : .y ���/� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �_ �1 **����� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 6, 2000
Transmitted herewith is a copy of application No. 2516 for a Cesspool/Septic Tank Construction
Permit submitted by:
James Fitzgerald Jr for William Manos
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:
�U /10 /D :)
Signature
D d
'OFtICE OF THE TOWN CLERK " ,,
Town of Southold � , �C `U�K �
CD Application No. Igs�(
Judith T. Terry, Town Clerk • �`� � Gym
Town Hall, 53095 Main Road /� Construction t�
P. O. Box 1179 vI
Southold, New York 11971 stt� W,; Alteration
Telephone ,j- �Qi' $10.00 - Residential
(516) 765-1801 � �
F,�,���
��' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
RECEIVED
for
CONSTRUCT ION or ALTERATION PERMIT OCT 6 2000
SEPTIC TANK or CESSPOOL wtho1d town Cork
Permit No.
Fee $
DATE 10/6/00
APPLICANT NAME: James E. Fitzgerald, Jr.
APPLICANT ADDRESS: PO Box 617
Cutchogue, NY 11935
SEPTIC g CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
New dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: William Manos
OWNER MAILING ADDRESS: 40-20 221st St
Bayside NY 11361
OWNER PROPERTY ADDRESS: 12035 Sound View Avenue, Southold NY 11971
TELEPHONE NUMBER OF CONTACT PERSON: 734-5800
TAX MAP NO. : Section 54 Block 5 Lot 46. 1
CROSS STREET: Horton Lane
BUILDING PERMIT NUMBER CROSS REFERENCE: ,
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411
41111r
Signat '= of .plic. t
RECEIVED BY:
Town Clerk's Office
DATE:
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