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ELIZABETH A.NEVILLE �is ��� Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Q �'�� Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `=��®D s,s22, ?�\ 10 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
SOUTHOLD riNASTIZAVOCEIRTEUXBDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2564 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GUSMAR REALTY CORP
Address 1 : 13-15 37TH AVENUE
City St Zip LONG ISLAND CITY NY 11101
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 #R10-00-0110
Name Of Owner GUSMAR REALTY CORP
Mailing Address 1 13-15 37TH AVENUE
•
City St Zip LONG ISLAND CITY NY 11101
Property Address 1 MARINA LANE
City St Zip EAST MARION NY 11939
Tax Map No. section 35.00 block 8 lot 5.011
Cross Street SHIPYARD LANE
Building Permit Number Cross Reference:
Issue Date: 5/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH-"A:NEVILLE ; ;l;. �1� Town Hall, 53095 Main Road
TOWN CLERK "`' - ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS eve I Southold, New York 11971
MARRIAGE OFFICER � 1b Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER $O/ ss�`,, Vs
Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER z�' ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 24, 2001
Transmitted herewith is a copy of application No. 2654 for a Cesspool/Septic Tank Construction
Permit submitted by:
Gusmar Realty Corp.
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:
Si ature
it I ) 6 (
Dated
-"'--OFFICE OF THE TOWN CLERK 11'�G,,,c•,t..,..v.,�n�,I
TOWN OF SOUTHOLD �'�OJ�11 O�n`�G Application No. a(0511
FI.i7ABETH A.NEVILLE,TOWN CLERK y
P.O.BOX 1179 Construction ✓
SOUTHOLD,NEW YORK 11971 Z
s • rr ' Alteration
Telephone % ,f s,./ $10.00 -Residential _
(631) 765-1800 = l ,to' $25.00 -Non-Residential
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TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
RECEIVED
Permit No. APR 2 4 2001
Fee $ uodhead brown Clerk
DATE ;cf-A.7
APPLICANT NAME: CJA4,414,4e r.e2io
APPLICANT ADDRESS: 41-- / S . 7 `` ,4 fC
BSc if. //r / •
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
ro4)97-40(77 ex] P79-101 I C-4
LOCATION MAP_: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 6G/50-1,4-/C.. Cz/'
OWNER MAILING ADDRESS: 4.3N- S 3 72 '1i"4
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OWNER PROPERTY ADDRESS: - J9 f3ob
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TELEPHONE NUMBER OF CONTACT PERSON:' ` -)9 -
TAX MAP NO. : Section 7j rj Block Lot 5 ( ( •
CROSS STREET: - k P\ (') LA , E N
BUILDING PERMIT NUMBER CROSS REFERENCE:
:gle)e-7
Sig at-re o Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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cQ �$k\ i �` I • THIS PLOT PLAN WAS PREPARED FROM OFFICE DATA AND FROM
�t '1 9 ��ot INFORMATION SUPPLIED BY THE DEVELOPER. THIS PLOT PLAN
-J S� ��o�°,�o� \!}� SHALL NOT BE USED FOR TITLE PURPOSES.
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"9� ,`rO0 F� .,,�'S� G�5 Suffolk County, New York
0, <cP 414 County Tax Map District 1000 Section 35 Block 8 Lot 5.1
t. NOTES BUILDING PERMIT SURVEY
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AREA = ;30215 SQ. FT.
• SUBDIVISION MAP FILED IN ITHE OFFICE OF THE CLERK OF AMENDED BUILDING PERMIT DATA APR. 6, 200(
SUFFOLK COUNTY ON NOV. 22, 1993 AS FILE NO. 9426. MAP PREPARED JAN. 28, 1995.
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•VERTICAL DATUM = N.G.V. 4ATUM (M.S.L. 1929)
• ELEVATIONS SHOWN HEREON MAY BE FROM MAPS OR SURVEYS SCALE 1" = 40'
PREPARED BY OTHERS AND ARE SUBJECT TO FIELD VERIFICATION. JOB NO. 99-0049
DWG. NO. 990049