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ELIZABETH A.NEVILLE �� �d Town Hall, 53095 Main Road
TOWN CLERK ; = P.O. Box 1179
%REGISTRAR OF VITAL STATISTICS ,� Southold, New York 11971
MARRIAGE OFFICER �o y • ° ���� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER - ®e c�00 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �' ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2547 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LOUIS O. GIGLIOLI
Address 1 : 63 2ND STREET
City St Zip BROOKLYN NY 11231
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 GIGLIOLI, LOUIS & PATRICIA
Mailing Address 1 63 2ND STREET
City St Zip BROOKLYN NY 11231
Property Address 1 1275 BUNGALOW LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 3 lot 17.000
Cross Street PARK AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE Id Town Hall, 53095 Main Road
TOWN CLERK % ® ti
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS (16; 3 , .. P �� Southold, New York 11971
MARRIAGE OFFICER � s� $ */ Fax (631) 765-6145
,
RECORDS MANAGEMENT OFFICER = ®1 • 1,t ti Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ass.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 3, 2001
Transmitted herewith is a copy of application No. 2635 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Louis O. Giglioli by Artco Drainage
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.
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OFFICE OF THE TOWN CLERK ''i •
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TOWN OF SOUTHOLD 41"4OG= Application No.Q4 5
BLIZABETH A.NBVILLE,TOWN CLERK
P.O.BOX 1179 : Construction
SOUTHOLD,NEW YORK 11971 k
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Alteration
Telephone •
,f �Q � $10.00 - Residential
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(631) 765-1800 �3'�l• �,0 $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 413/azo
APPLICANT NAME: L90(S Com_ a i bo/(-
APPLICANT
o/APPLICANT ADDRESS: /� 2 S 6GG(YG Cow7YL-
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SEPTIC
1%.---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: 40u/s d / r/L G /6 4w e_/
OWNER MAILING ADDRESS: o 3 a1° Sr
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OWNER PROPERTY ADDRESS: /.7 s- l36tYG/2-Lo(J 4/M/6—
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 4P-3 ,Block ,6 3 Lot /7
CROSS STREET: tmK , //'c ' -
BUILDING PERMIT NUMBER CROSS REFERENCE: __
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Signature of,pplicant
RECEIVED BY: AL.
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DATE: O^�
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