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ELIZABETH A.NEVILLE � y\4.
� Town Hall, 53095 Main Road
TOWN CLERK o= -� P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823
MARRIAGE OFFICER ��
RECORDS MANAGEMENT OFFICERtit�! '08.11�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER jig
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1998 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MARK SCHWARTZ
Address 1 : 275 CLEARVIEW AVENUE
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 #R10-98-0177
Name Of Owner SCOTT & LAUREN GAMBAIANI
Mailing Address 1 PO BOX 334
City St Zip SOUTHOLD NY 11971
Property Address 1 CROWN LAND LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 7 lot 2.000
Cross Street SPUR ROAD
Building Permit Number Cross Reference:
Issue Date: 2/18/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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I 1 �,�-'S1FFOL,�-•-
ELIZABETH A.N Ii 1999 l��) , '' ' co. "l/. Town Hall, 53095 Main Road
TOWN C .ERK t 10 4 • P.O. Box 1179
�� ,+„�. 4 y % Southold, New York 11971
REGISTRAR O VIT•i- , V:A. � li., , • 1.3� rrt
� '1 Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER 4% �� ,�� 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: February 5, 1999
Transmitted herewith is a copy of application No. 2084 for a Cesspool/
Septic Tank Construction Permit submitted by:
Mark Schwartz for Scott and Lauren Gambaini
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 recommendations:re
APPROVE e/
DISAPPROVE
Comments:
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Dated
• OFFICE OF THE TOWN CLERK , O 001./ /,�Vst
h�.
TOWN OF SOUTHOLD �' 1 CO _
Application No.
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 : Construction (/
SOUTHOLD,NEW YORK 11971 ; =O
Alteration
Tele hone ‘ ,� '� $10.00 - Residential
(516) 765-1801 _ 4i *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 2/ S 79
APPLICANT NAME: AMr ( ,A"V1 Z -
APPLICANT ADDRESS: 77 C/( (A (JG ✓
SEPTIC CESSPOOL
DESCRIPTIONA �►�� OOF PROPOSED CONSTRUCTION OR ALTERATION
/1�q i4A J�ie 6
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Sc,� 4-0 (,/f" E-' 6,h/trim//c'
OWNER MAILING ADDRESS: r.o. eoX 331-
S(>v iop) ,vy I / ?7I
OWNER PROPERTY ADDRESS: Gfe(/bj/j GM-A442 (Avg
Gr1'CfiVC ut
TELEPHONE NUMBER OF CONTACT PERSON: ( 6
TAX MAP NO. : Section J o Block Q 7 Lot 0 Z
CROSS STREET: ' r(')e- /2.-04 40
BUILDING PERMIT NUMBER CROSS REFERENCE:
%0
Signature if Applicant
RECEIVED BY :
Town Clerk's Office
DATE: t /O7/��
N/F KA L OSKI (OPEN FIELD) .%\\----....\
45.0 N 47' 26' 10" W `` 200.0'
- 5 1/2'AVG. ENCROACHMENT OF PLOWED FIELD _ J
PROPOSED WELL
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46
16' X 32'
IG POOL 48
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25' 60'
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CC 25' GARAGE 2 STORYD
4 BEDROOM
WOOD FRAME RES. 35'
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CROWN U LANE
SUFFOLK OOUNr y DEPART ME1rTI OF HEALTH SERVICES I
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE 7�FAMU..AY RESIDENCE ONLY
DATE t)[ -' ?i -)' .iii„ Guarantees ind
� IQ /q�< �� u . only to the pe
APPROVED is prepared,
1 FORMA title cc mpcny,
,_JM OF BEDROOMS tendM9 insrituti
to the essignei
EXPIRES THREE YEARS FROM DATE OF APPROVAL to the tees cr
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