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JUDITH T. TERRY % y.4. Town Hall, 53095 Main Road
TOWN CLERK Z i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t=i Southold, New York 11971
MARRIAGE OFFICER y Fax (516) 765-1823
T� Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 672 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SEA BREEZE CESSPOOL
Address 1 : P. O. BOX 156
City St Zip CUTCHOGUE NY 11935
Descripton of Proposed Construction or Alteration
ADD NEW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. HOLD 15'0" SEPARATION DISTANCE. EXCAVATION
INSPECTION REQUIRED. CALL 765-1802 FOR AN APPOINTMENT.
Name Of Owner GAMB I NO, ANTHONY
Mailing Address 1 DEEP HOLE DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 DEEP HOLE DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 12 lot
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 1/14/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
JAN 71991
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H1 095 Road
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4,‘ TOWN TOWN OF SOUTH , 'a1O.53Baix 1 179Main
-'`.7.f :I[ N 00. • ' • =;,„N York 11971
JUDITH T. TERRY '��������� TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Janaury 4, 1991
To: Southold Town Code Enforcement 'Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A690 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Seabreeze Cesspool for Anthony Gambino
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - ,)c
DISAPPROVE -
COMMENTS: /S a a.l. ,;M L. -0/'0141 t.k_
aso-ortaA:AYN
114951 Signature
Cp►�p�ON 1RT��
REQu j g i 9 •
Date
OFFICE OF THE TOWN CLERK ""
Town of Southold
Judith T. Terry, Town Clerk � �� l/ Application No.6 P'
Town Hall, 53095 Main Road . ; Construction
P. 0. Box 1179 ,'ic,
Southold, New York 11971 Alteration
Telephone O,j► Q7 $10.00 - Residential
(516) 765-1801 �l 4',,'�� $25.00 -Non-Residential
...,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE lq-16t I
APPLICANT NAME: �� p ree 2 C C e 5 519001 sty G
APPLICANT ADDRESS: M&I1i AO °r►ch
SEPTIC CESSPOOL Y
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Od he
C e55QQdl
LOCATION MAP: Must be attached hereto before permit may be issued.
' LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: COT`t101�/ (mil., p,; no
OWNER MAILING ADDRESS: `
OWNER PROPERTY ADDRESS: Pete HDD l e. V rJ v m A 11 1 uo1c
TELEPHONE NUMBER OF CONTACT PERSON: 3 Z3 3415 t
TAX MAP NO. : Section //S— Block Lot ,2()
CROSS STREET: rI r'✓ 51)(-r' K e)t✓
BUILDING PERMIT NUMBER CROSS REFERENCE:
,<C4/ 7/46P1)11
Signature of Applicant
RECEIVED BY: /1/
,
Town Clerk's Office
DATE: l`c,l7?f
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