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ELIZABETH A. NEVILLE �/= OG# Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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y, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 4Fax(631) 765-6145
MARRIAGE OFFICER Oy 1',
RECORDS MANAGEMENT OFFICER '�Ql *a�/ii Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER "a,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2265 R Residential X Non-Residential
Fee $ 10.00 Septic • X Cesspool
PERMIT ISSUED TO:
Name : DOUGLAS MC GAHAN
Address 1 : PO BOX 602
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 #R10-00-0033
Name Of Owner GOLDE, BILL & MARIE
Mailing Address 1 152 QUARER PATH
City St Zip SETAUKET NY 11733
Property Address 1 1320 HARBOR LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 1 lot 20.010
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 3/21/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE ��_ ; ' 1 2BOO Ttown Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
♦ Va
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♦ , outhold, New York 11971
y,
REGISTRAR OF VITAL STATISTICS Q Fax (631) 765-6145
MARRIAGE OFFICER y `. l'
RECORDS MANAGEMENT OFFICER ?�Ql a0��e Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 6, 2000
Transmitted herewith is a copy of application No. 2353 for a Cesspool/
Septic Tank Construction Permit submitted by:
Douglas McGahan for Bill and Marie Golde
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application nd location map of the project cited above
and make the following reco endations:
APPROVE
DISAPPROVE
Comments:
ignatur
3/14v
Dated
OFFICE OF THE TOWN CLERK ;, 'C�VFF�L '_
TOWN OF SOUTHOLD Application Nd. S 3
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 Z ;L� Construction
v
SOUTHOLD,NEW YORK 11971 0
Alteration
Telephone 0A $10.00 - Residential -/
(516) 765-1801 O! l ��' $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
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APPLICANT NAME: -u L j M tisd (N) 04w jj ((q
APPLICANT ADDRESS: Z0>-0 fi 134\r- t) y
SEPTIC I CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY: 131,LL is '(Vt2B i'L .-E7
OWNER MAILING ADDRESS: 15 QJ -� -(
c i-7 -'}cam- ► - �� 33
OWNER PROPERTY ADDRESS: VeljaO kVe,..dlyek �5
TELEPHONE NUMBER OF CONTACT PERSON: 33L(- (,719-0
TAX MAP NO. : Section k Q3 Block 0 '. Lot 2.0 . 1 q
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
�\I t
Signa • ego applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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COUNTY DEPAR'i FWHEAL=SERV=
IMAM DORZ APPROVALQI►DONSTRUCTIONFOR A
FAMILY ONLY
ens a. a-Y- -0 1fl , rho . 0033 •
APPROVED /�,�'\
FOR MA3OMUMOF__„s aoOMs
• $XP3RES7IREE YEARS FROM DATB OF APPROVAL
,AL9ribed