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ELIZABETH A.NEVILLE �' ?�: Town Hall, 53095 Main Road
TOWN CLERK P.O.y Box 1179
REGISTRAR OF VITAL STATISTICS Pr, tSouthold, New York 11971
MARRIAGE OFFICER � y / Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_'-'/® ��®iiFax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER �,��'�
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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. 2481 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GENDOT ASSOCIATES
Address 1 : PO BOX 534
City St Zip WADING RIVER NY 11792
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 # R10-99-0136
Name Of Owner LINAKIS, STEPHAN & STEFANIE
Mailing Address 1 18 PARKWAY DRIVE
City St Zip SYOSSET NY 0000
Property Address 1 PRIVATE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 122.00 block 9 lot 7.018
Cross Street CAMP MINEOLA ROAD
Building Permit Number Cross Reference:
Issue Date: 12/011/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
- OFFOUr 9(fV
ELIZABETH A.NEVILLE : Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % 1' � Southold, New York 11971
%MARRIAGE OFFICER �� y � �1�, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ? '/®diNg *4;00 Telephone (631) 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: December 4, 2000
Transmitted herewith is a copy of application No. 2569 for a Cesspool/Septic Tank Construction
Permit submitted by:
Gen dot Associates
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
Sign at 40
127 4 cam„
Dated
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OFFICE OF THE TOWN CLERK ''1�C.��FFotK6
TOWN OF SOUTHOLD fe'� QGy Application No.2S�9
F.17ABETH A.NEVU.IP,TOWN CLERK t.
P.O.BOX 1179 z Construction
SOUTHOLD,NEW YORK 11971
I" Alteration
Telephone -0�� ,0 ��Qri' $10.00 - Residential ()4......„,(631-) 765-1800 1
$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 C .ZI9 ° b
wI
APPLICANT NAME: U0r1CALS �/)C.,
APPLICANT ADDRESS: '60?. LI f,IAd1) �<f U v11 f l'")9'2-- ‘
SEPTIC J_CESSPOOLv"
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
G5S ,omapink -scp, c '-1 5 ,.(1-4.r)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CON T(RUCTION R ALTERATION: •
OWNER OF PROPERTY.oiv e S-/ iu,, Liep c i'S
OWNER MAILING ADDRESS: 1 P12I61A1 al. 5\101 -4
g
,
OWNER PR� RTYtADD °ESS: ,2 vAk (�d ' f n •¢- 1 `' CArTpI '/1 01
r k
TELEPHONE NUMBER OF CONTACT PERSON: 63 )-9 Z961O1
TAX MAP NO. : Section Li Block 9 Lot 1• r
(Ally CROSS STREET: Ofkb n ,d .
BUILDING PERMIT NUMBER CROSS REFERE C : 1 .
61
Signature of Applicant
RECEIVED BY: &r______S•N
wn Clerk's Office
DATE: /...)---/7/00
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR .
WHOSE SIGNATURE APPEARS HEREON ; ,_•,s�+�_
a 9
II SURVEY OF PROPERTY
200. 1._
AT MATTITUCK
e w
TOWN OF SOUTHOLD
51'� 5 0Pefi'9" \-
rop water Plan SUFFOLK COUNTY , N. Y.
/ P ' 1000-122-09-7.1 @
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` si.o� 26:., Its _ _ to. _Lr*el SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
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