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ELIZABETH A.NEVILLE P.`10� 0Gy��a Town Hall, 53095 Main Road
TOWN CLERK 1
ti Southold,
P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS %O ��� Fax (516) 765-1823
MARRIAGE OFFICER : ifi 1
RECORDS MANAGEMENT OFFICER 01 ���01� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER s'
of
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2202 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ULLYSSES GALLANOS
Address 1 : C/O PATRICIA MOORE
City St Zip SOUTHOLD NY 11971
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 #R10-99-0159
Name Of Owner EDSON, L. P.
Mailing Address 1 PO BOX 1526
City St Zip SOUTHOLD NY 11971
Property Address 1 660 HOBART ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 64.00 block 1 lot 28.000
Cross Street KORN ROAD
Building Permit Number Cross Reference:
Issue Date: 12/21/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
of Four --_ a
ELIZABETH A.NEVILLE ���`t` Gy: Town Hall, 53095 Main Road
TOWN CLERK p • ‘ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v. Southold, New York 11971
MARRIAGE OFFICER G 1� Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER 'y4e ao`.0 ,
� ,f' Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER " " L 4 •�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 6, 1999
aag0
Transmitted herewith is a copy of application No. D-7-94 for a Cesspool/
Septic Tank Construction Permit submitted by:
Ulysses Gallanos by Patricia C.Moore
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 and location map of the project cited above
and make the following reco mendations:
APPROVE
DISAPPROVE
Comments:
ignatu
Dated
I f
OFFICE OF THE TOWN CLERK ,
TOWN OF SOUTHOLD ' 7V
Q Application No.2.2-90
FT I7ABETH A.NEVIJ.i.F,TOWN CLERK ' T
P.O.BOX 1179 -?104:1: Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone lb„
$10.00 -Residential
(516) 765-1801 = 4 *1,„'' $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 /°0/
APPLICANT NAME: 1%6/55 6-J 671410S
APPLICANT ADDRESS: 0 (% /3,6t�-e C_ 69 -,—
/ 5/020 /k7(;) ,fid, ,Soy;fro /c/ A
SEPTIC 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: L,
OWNER MAILING ADDRESS: P.O. i;ado 15' L
OWNER PROPERTY ADDRESS: 6 60 1obwr+
TELEPHONE NUMBER OF CONTACT PERSON: edTAX MAP MAP NO. : Section t L1 Block a Lot 2?
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
ow l- 's Office
ar
DATE: /,
II,
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• MAIN ROAD SURVEY OF PROPERTY
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