HomeMy WebLinkAboutGunn, Phyllis ,/��,o��g�FFO�,�CO
•
ELIZABETH A. NEVILLE f i Gy� •
Town Hall, 53095 Main Road
TOWN CLERK ` C P.O. Box 1179
y Z
.y, nti Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V O Fax (631) 765-6145
MARRIAGE OFFICER ``yo am� i e Telephone (631) 765-1800
RECORDS MANAGEMENT OFFICER A. �
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. 2406 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PHYLLIS GUNN
Address 1 : 558 AVALON GARDENS DRIVE
City St Zip NANUET NY 10954
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 #R10-00-0024
Name Of Owner GUNN, PHYLLIS
Mailing Address 1 558 AVALON GARDENS DRIVE
City St Zip NANUET NY 10954
Property Address 1 2145 LITTLE PECONIC BAY LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 90.00 block 1 lot 15.000
Cross Street PRIVATE ROAD
Building Permit Number Cross Reference:
Issue Date: 9/20/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
(V06
„i o FO14'
ELIZABETH A. NEVILLE ���a- 1) �,\,! fr4 rl 'tin Hall, 53095 Main Road
TOWN CLERK ; y Z `� i P.O. Box 1179
14
REGISTRAR OF VITAL STATISTICS Pry,'�� I Cuthold, New York 11971
��
MARRIAGE OFFICER if, ! �1 r Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �aQI ! Tlephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���r�` "'"••J
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 15, 2000
Transmitted herewith is a copy of application No. 2495 for a Cesspool/Septic Tank Construction
Permit submitted by:
Phyllis Gunn
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:
ature
g119l66
Dated
OFFICE OF THE TOWN CLERK ' �Ff OCK
TOWN OF SOUTHOLD � 0� �D Application No.,KK95—
ELIZABETH A.NEVILLE,TOWN CLERK ��/,,
P.O.BOX 1179 � . Construction
SOUTHOLD,NEW YORK 11971 ipm
Alteration
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Telephone 0� Q�:� • $10.00 - Residential
(516) 765-1801 - ' I �of'/ $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: Phyllis Gunn
APPLICANT ADDRESS: 558 Avalon Gardens Dr.
•
Nannet '\l,Y_ 10954
SEPTIC CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Complete waste water disposal system for new home
single family resi_dance
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Phyllis Gun
OWNER MAILING ADDRESS: 558 Avalon Gardens Dr.
Nanue e, n23a
ADDRESS: � al � ` . _
OWNER PROPERTY _ • -_ •
@West 1., 1c-i -Ssuthold N.Y.
TELEPHONE NUMBER OF CONTACT PERSON: Peter G n
TAX MAP NO. : Section 090 Block 1 Lot 15
CROSS STREET: Ceder Point Dr.. West
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY: /(\i/
Town C erk's ffice
DATE: l l5 C
SURVEY OF
I. ao mg I.
To O.V.D. 11120 OATir1 LOT 12 9
ammo
KISSING ELEVATIONS AS SHOWN TINSc NRA
: RErER To race LNCP POR 031 Na.E OAT*. MAP OF
U�1 & nom=OMAN METER '"""""""°" TIM CEDAR BEACH PARK
RLE No. 90 FILED DECEMBER 20. 1927
� ePOOPOINIO WANE=POOL
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,�I�4Y ./ �,�. ® TANNIC BAYVIEW
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. �.i t ROOD INSIMMEZ RATE IMP „01 Q SUFFOLK COUNTY, NEW YORK
SONE it ONE ROOD OUNAR 1M ttElorNNmL S.C. TAX No. 1000-90-01-15
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