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JUDITH T. TERRY • t` Town Hall, 53095 Main Road
TOWN CLERK : o ,Z 1 P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �. ,% Fax (516) 765-1823
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MARRIAGE OFFICER �� �O $•' Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER `—. 'C9/ 4 ►�
FREEDOM OF INFORMATION OFFICER „,,,,•
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1159 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PETER AND JENNIFER GATZ
Address 1 : P. O. BOX 1735
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF #R10-94-0056
Name Of Owner GATZ, PETER
Mailing Address 1 P. O. BOX 1735
City St Zip MATTITUCK NY 11952
Property Address 1 3115 REEVE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 3 lot 4.018
Cross Street SOUND VIEW AVE
Building Permit Number Cross Reference:
Issue Date: 7/07/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
.JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK : p T : P.O. Box 1179
to *' � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO Fax Fax (516) 765-1823
MARRIAGE OFFICER '_., V> 10 0 Telephone (516) 765-1801
RECOFREEDOM OS F MANAGEMENT
ON OFFICER X10, 0011 4111 '�II
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD `
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JUN29 —,
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office TOWN pF SOUTHOLD
DATED: June 28, 1994
Transmitted herewith is a copy of application No. 1203 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter and Jennifer 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 recommendations:
APPROVE �
DISAPPROVE
Comments: i --- -ica iZ�� --,den '
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Signator 1
Dated
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OFFICE OF THE TOWN CLERK c,VFFOur„,
Town of Southold '‘ ' . 14
Judith T. Terry, Town Clerk ' _ : Application No./.°26)
Town Hall, 53095 Main Road - 41- Construction
P. O. Box 1179
Southold, New York 11971 `J Alteration
11 �� '* Residential [i'
Telephone ,
(516) 765-1801
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE (C3 , aC , I9 9
APPLICANT NAME: -C--. 3rIrl 'CQ_;C
1 -
APPLI CANT ADDRESS: 3 I c r-ReC' ' '\\o d
a-V\ (-k-K-K N'I ) l9 S
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: `c \--\ . 6:0---a_
OWNER MAILING ADDRESS: ? C' ZCIY-1\ ` -1 -3S
MG--4 C_ . IN),Y \l q 5 a
OWNER PROPERTY ADDRESS: 311 S Peexre__ \, po.d
MQ -IA i W CX l '(' 1 0 a
TELEPHONE NUMBER OF CONTACT PERSON: �(
TAX MAP NO. : Section 9 1 Block Lot I + 1
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
"qa_ •GO5
Sig . of Applicant
RECEIVED BY: ' ' ,•
own Cle k's Office
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ExevER THREE TENS FROM DAME OF APPROVAL gP\`' JUN 6 1994
SURVEY FOR a.G. DCf T. QF
PETER GATZ HEALTH SERVICES
MAY 24,1994
SUFFOLK COUNTY DRPARTMENT Of HEALTH SERVnCt; LOT NO. 18 ,` HONEYSUCKLE HILLS' JUL. 8,1991
JUN. 10 1991
fqt ovAL Of ca+svQUC7K DREG AT MATTITUCK DATE: APR. 18,1991
TOWN OF SOUTHOLD SCALE: I" = 30'
SUFFOLK COUNTY, NEW YORK NO. 91 -0268
GATE, V3 • .:moi: -.4
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M UTHOR12E0 ALTERATION OR ADDITION TO THIS CERTIFIED TO:
SUR Y IS A VIOLATION Of SECTION 7209 OF THE PETER GATZ
� �� .CA'-��._- A NCOPIE K Cr STATEIS ESURVEYNOTA SEARING THE LAND SUFFOLK COUNTY NA
• 'S INKED SEAL OR EMSOSSED SEAL SHALL
*GUARANTEES RAII NT[EfDINDICATED HLNLO• M D L NUN ONLY 10OPY
W t.Icit,.\THE PERSON FOR WHOM THE tURVEY L PREPARED �HEALTH DEPARTMENT-DATA FOR A TO CONSTRUCT AHD ON SO SENAIf M THE TITLE COMPANY AR ERN- IIw wNN[AIKST WATER WN MI.! *SOURCE OF WATER.PRIWITE_PUKIC_ MENTAL AGENCY ANO LENDING INSTITUTION LISTED r, 1N SI/►CO.TAKMAP DIST2.SECTION MACK-L LOT L HEREON,AND TO THE ASSIGNEES OF THE LENDING r "� .l1
HTMERE ARE ND MELLOWS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE ' `.i. f
OTHER THAN THOSE SHOWN HEREON. TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT ;LdT
OWNERS
N THE INTER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE FyvR/Ldl , -_
vn I mi.,. T YMP fY•YMM•„,„snRn r ,,„. V„...YPMT if DISTANCES SHOWN HEREON FROM PROPERTY UNES , (A , w ';