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ELIZABETH •
A.NEVILLE 1', \��� �d Town Hall, 53095 Main Road
TOWN CLERK % P.O.Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER � %/i Veil. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
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OFFICE OF THE TOWN CLERK
SOUTHOLD VONSIREMSTEIBTIELIMPXDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2586 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JACK GAMBLE
Address 1 : 245 BRAY AVENUE
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner GAMBLE, JACK
Mailing Address 1 245 BRAY AVENUE
City St Zip LAUREL NY 11948
Property Address 1 245 BRAY AVENUE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 2 lot 3.000
Cross Street MAIN ROA
Building Permit Number Cross Reference:
Issue Date: 5/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� � Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ®d �4 '11�� 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: May 9, 2001
Transmitted herewith is a copy of application No. 2674 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Jack Gamble
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: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signator
sl « 1 c.9 �
Dated
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yf OFFICE OF THE TOWN CLERK •'��1��."„...�-���' ..**��//
TOWN OFSOUTHOLD ',�� Application No..2C�7'
Fr VABETH A.NEVILLE,TOWN
P.O.BOX 1179 .G Construction
SOUTHOLD,NEW YORK 11971 o T
• Alteration ic<
Telephone 0,��0 ��Q�;,'$ $10.00 - Residential
(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 '5----
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APPLICANT NAME: /,fief Ca47 a
APPLICANT ADDRESS: 2yr /44I., iOv� •
Laarlr'� /v,r „ „:_/,z,
SEPTIC CESSPOOL X
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: z.4c* 67, ,d4
OWNER MAILING ADDRESS: 2.f/, -- 4F,-,g9e. , 47-
z„,,..„-/ 447 /1 �3/z-- /4z/
OWNER PROPERTY ADDRESS: 2y.,--,R-..9t, 4Le
.1,1 - ' / er /)f C -/6a/
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section /2 4 Block g Lot
CROSS STREET: / YA, /t,/
BUILDING PERMIT NUMBER CROSS REFERENCE:
ignat e o Applicant
RECEIVED BY:
o n erk's Office
DATE:
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