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ELIZABETH A. NEVILLE ���• �'��: Town Hall, 53095 Main Road
TOWN CLERK % P.O. Box 1179
PryREGISTRAR OF VITAL STATISTICS 6 � Southold, New York 11971
MARRIAGE OFFICER sae �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =__ ‘91 *too. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER r�i
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2557 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MARGARET GILBERT
Address 1 : 36 OXFORD DRIVE
City St Zip MELVILLE NY 00000
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 #R10-01-0064
Name Of Owner GILBERT, MARGARET
Mailing Address 1 36 OXFORD DRIVE
City St Zip MELVILLE NY 0000
Property Address 1 MINNEHAHA BLVD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 87.00 block 3 lot 32.000
Cross Street OWAISSA AVENUE
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 �� �� #� Town Hall, 53095 Main Road
TOWN CLERK ; n ,t P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS j /+a Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER $1®�0� 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: April 13, 2001
Transmitted herewith is a copy of application No. 3645 for a Cesspool/Septic Tank Construction
Permit submitted by:
Margaret Gilbert
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:
ignature
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Dated
OFFICE OF THE TOWN CLERK ��� `\ K/�
TOWN OF SOUTHOLD '���o��FFUL "`Q Application No.
ELIZABETH A.NEVIJI.F,TOWN CLERK 0 t
P.O.BOX 1179 Construction A--
SOUTHOLD,NEW YORK 11971 =v • rn
Alteration
Telephone t-204.1, $10.00 - Residential
(516) 765-1801 = ?l * 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 iO3/0,/
Aziktit
, APPLICANT NAME: / /,
APPLICANT ADDRESS: ilifivue
otaaa
SEPTIC l CESSPOOL,
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/114#'/1,014 d 'a ac •
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR A TERATION:
OWNER OF PROPERTY: / , • •
OWNER MAILING ADDRESS: 40,,Ai&t .
i
OWNER PROPERTY �%�ADDRESS: "a/Ltw .
TELEPHONE NUMBER OF CONTACT PERSON: en- 179s/
TAX MAP NO. : Section 7 Block 3 Lot 3 �.
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
mud
Signature of Applicant
RECEIVED BY: 1+�.
Town Clerk's Office
DATE: �j�D
ireP
p SURVEY OF PROPERTY
` SITUATED AT
TEs wI HOLE DATA : � LAUGHING WATER
HOLE DUG BY Mc a-{e►n GEOSCIENCE ON FEBRUARY 13, 2001)
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= i%r ���� `�Q, TOWN OF SOUTHOLD
,� A ��� SUFFOLK COUNTY, NEW YORK
/ BROMN LONIY sA1D Sal
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S.C. TAX No. 1000-87-03-32
/ +� OL�C fAUi�fi`Y D A�T'i JF I�rAL7'H 3;, VICES ;0 .
SCALE 1;
=30
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1������i�i� BROI..SILTY SRO sr PERIFJEIT FOR APPR QVA L`,)F,wol+3.s'r`�iij�'.'�'I�.�N ..,' J FEBRUARY 27. 2001
LMARCH 9, 2001 REVISED PROPOSED'HOUSE umknoN
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