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JUDITH T. TERRY : 'meL; Town Hall, 53095 Main Road
TOWN CLERK : p rrn P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER y0 �- �, Fax (516) 765-1823
'y0 ��� ��� Telephone (516) 765-1801
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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. 907 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CHARLES C. GERBER
Address 1 : P. O. BOX 769
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF OVERFLOW CESSPOOL TO AN EXISTING SYSTEM.
APPROVED. HOLD 10'0' SEPARATION BETWEEN EXISTING AND PROPOSED POOL.
EXCAVATION INSPECTION REQUIRED. CALL 765-1802 FOR AN APPOINTMENT.
Name Of Owner GERBER, CHARLES C.
Mailing Address 1 P. O. BOX 769
City St Zip MATTITUCK NY 11952
Property Address 1 17950 MAIN ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 4 lot 15.000
Cross Street CARDINAL DRIVE
Building Permit Number Cross Reference:
Issue Date: 9/18/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
111
JUDITH JUDITH T. TERRY Town Hall, 53095 Main Road
= z P.O. Box 1179
TOWN CLERK p rT
REGISTRAR OF VITAL STATISTICS in �` Southold, New York 11971
MARRIAGE OFFICER y0 �- �, Fax (516) 765-1823
,yo �1�� ��� Telephone (516) 765-1801
4itOryx, - OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 8, 1992
To: Southold Town Code Enforcement Officer
From: Linda J. Cooper, Southold Town Clerk's Office
Transmitted herewith is a copy of application No. A931 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Charles C. Gerber
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.
e
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE - nn
COMMENTS: 44..4.1,41 I D -s g. hx�N►,. V+L .u�tt. a4.4
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Signature
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Ailth Date
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OFFICE OF THE TOWN CLERK ,,'""""'
Town of Southold ,cgV111.ke,S
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Judith T. Terry, Town Clerk � � , y'�
Application No. t
Town Hall, 53095 Main Road Z Construction
P. O. Box 1179 • _
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Southold, New York 11971 to .` Alteration
Tele hone , �Q��' $10.00 - Residential
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(516) 765-1801 �Ol ��
� $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE q - g
APPLICANT NAME: L4-I4}�L S � &ER jP
APPLICANT ADDRESS: )7q5 p p-- Zg- ?o Ro”c -1 („Ct
SEPTIC CESSPOOL >(
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: / L,L
OWNER MAILING ADDRESS: pp ox `T k)q- e c 2-5-
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OWNER PROPERTY ADDRESS: $ , r,-,
TELEPHONE NUMBER OF CONTACT PERSON: 2._qg '7 - L/ (
TAX MAP NO. : Section 1 l 5 Block 4/ Lot 15
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Applicant
RECEIVED BY:
own, erk s Office
DATE: , - 62
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