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Home My WebLink AboutGatz, DonaldELIZABETH A. NEVILLE TOWN CLERK REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-6145 Telephone (516) 765-1800 SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2092 R Residential X Non -Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : JACQUELINE MARIE GATZ Address 1: PO BOX 1486 City St Zip MATTITUCK NY 11952 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 #R10-99-0081 Name Of Owner GATZ, DONALD 8 JACQUELINE ------------------------------ Mailing Address 1 PO BOX 1486 ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Property Address 1 SOUND AVENUE ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- ------------ Tax Map No. section 121.00 block 1 lot 4.005 ------ --- ------ Cross Street COX NECK ROAD ------------------------------ Building Permit Number Cross Reference: Issue Date: 6/18/99 Eljze�thA. IE -3i t e Southold Town Clerk (TOWN SEAL) ELIZABETH A. NEVILLE Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 Southold, Ne�� York 11971 REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823 MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER ' Telephone (516) 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: June 7, 1999 a09 01, Transmitted herewith is a copy of application No. 2180 for a Cesspool/ Septic Tank Construction Permit submitted by: lacaueline Marie Gatz 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 recom ndations : APPROVE DISAPPROVE Comments: Xignature G �0 Q Q Dated 0 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD ELIZABETH A. NEVILLE, TOWN CLERK P.O. BOX 1179 SOUTHOLD, NEW YORK 11971 Telephone ( 516) 765-1801 Permit No. Fee $ TOWN OF SOUTHOLD Application No. 3 ` 60 Construction ✓ Alteration $10.00 -Residential $25.00 -Non-Residential SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Rre►F11a.m JUN 7 1999 Town Clerk swu.d DATE .lowl c APPLICANT NAME: OL e &1 e li hc, M a c Ad a_ zf APPLICANT ADDRESS: ) ?00 SoLmd 4venut d 800 low SEPTI ESSPOOL 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: 1 on all d ,Jaquelint • /JLL47, OWNER MAILING ADDRESS: Ab 60x mb 11 a ffi biti, g g1 114 (A . OWNER PROPERTY ADDRESS: { .)bund 4venuz mrxKb4_ty, L)eW �,)(X TELEPHONE NUMBER OF CONTACT PERSON: (S)I, TAX MAP NO.: Section a I Block CROSS STREET: BUILDING PERMIT NUMBER CROSS REFERENCE: - 3gy? Lot . Signature of Applic t RECEIVED BY Town Clerk's Office DATE: �� pLS O< � t GotiZ �o�Q 1P 1 \ �Nwo &te ��o `� \ ( 1�y Gott \ i D 0*0 6pl1 �" N�9y/E .N&ke` J` \ \ \ \ �� 261 92 N 6815 0 �,4�0 \ 0 E rR� �N U1 O N cN0 O \ 5' ;\ `t '. EnRn+ s STokAE SUFFOLK COUNTY T)EPARTMENT OF TEALTH SERVICES pERM1T FOR AP2ROVAL OF CON.3"S'F,U-- rT_0N FOR A Ni, FgANYiLY RISSIDENCE ONLY DATE -f 5 "y7 g -b Al, APPROVED FOR MAXIMUM OF BEDROOMS EXPIRES THREE YEARS FROM DATE OF APPROVAL NOTE p - �T WT ■ - ypIp NT Fd ®- STu WT A - su AREA = 6.1868 ACRES • REF: LOT 4 MINOR SUBDIVISION 'GREEN PASTURES' • VERTICAL DATUM - N.G.V. DATUM (M.S.L 1929) • THE WATER SUPPLY AND `SEWAGE DISPOSAL FACIUTIE HEREON COMPLY WITH hIE STANDARDS AND REWREME, THE SUFFOLK COUNTY DEPARTMENT,OF HEALTH SERjW HOWARD W. YOUNG, N.Y.S. LS. NO. 458 THOMAS C. WOLPERT.. N.Y.S. P.E. NO. $40 • WE "EREBY CERTIFY TO SURVEY WAS PREPARED 1!I PRACTICE FOR LAND SURA ASSOCIATION OF PROFE� JOFIFI SCHNUule NO 40517 HOWARD W. �. L.S. NO 4bJl93 G SURVeY;FOR LOT 4 "GREEN pASTuRES" DONALD GA'fZ At Mattituck. Town of SoUthok \ lei`'ba :\ Z \ 6 0 E rR� �N U1 O N cN0 O \ 5' ;\ `t '. EnRn+ s STokAE SUFFOLK COUNTY T)EPARTMENT OF TEALTH SERVICES pERM1T FOR AP2ROVAL OF CON.3"S'F,U-- rT_0N FOR A Ni, FgANYiLY RISSIDENCE ONLY DATE -f 5 "y7 g -b Al, APPROVED FOR MAXIMUM OF BEDROOMS EXPIRES THREE YEARS FROM DATE OF APPROVAL NOTE p - �T WT ■ - ypIp NT Fd ®- STu WT A - su AREA = 6.1868 ACRES • REF: LOT 4 MINOR SUBDIVISION 'GREEN PASTURES' • VERTICAL DATUM - N.G.V. DATUM (M.S.L 1929) • THE WATER SUPPLY AND `SEWAGE DISPOSAL FACIUTIE HEREON COMPLY WITH hIE STANDARDS AND REWREME, THE SUFFOLK COUNTY DEPARTMENT,OF HEALTH SERjW HOWARD W. YOUNG, N.Y.S. LS. NO. 458 THOMAS C. WOLPERT.. N.Y.S. P.E. NO. $40 • WE "EREBY CERTIFY TO SURVEY WAS PREPARED 1!I PRACTICE FOR LAND SURA ASSOCIATION OF PROFE� JOFIFI SCHNUule NO 40517 HOWARD W. �. L.S. NO 4bJl93 G SURVeY;FOR LOT 4 "GREEN pASTuRES" DONALD GA'fZ At Mattituck. Town of SoUthok