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ELIZABETH A.NEVILLE � 'yam: Town Hall, 53095 Main Road
TOWN CLERK ; • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1��, Southold, New York 11971
MARRIAGE OFFICER �` 4 �1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER -_'�01 *wog.' 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. 2539 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC CESSPOOL
Address 1 : PO BOX 972
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.AMILY DWELLING.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENTMENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner GABEL, THEODORE & MILDRED
Mailing Address 1 9452 240TH STREET
City St Zip BELLEROSE TERRACE NY 11001
Property Address 1 12215 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 5 lot 4.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 3/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
ELIZABETH A. NEVILLE ail ` ry ; Town Hall, 53095 Main Road
t.TOWN CLERK ® k x P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �o Vr 6 �I Southold, New York 11971
MARRIAGE OFFICER :� • 0 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER ; ®1 �� �i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ �i'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 20, 2001
Transmitted herewith is a copy of application No. 2627 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Peconic Cesspool for Theodore & Mildred Gabel
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 cation 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 ' ULk ,
TOWN OF SOUTHOLD •' CJ CSG Application N6>2
ELIZABETH A.NEVILLE,TOWN CLERK • '
• P.O.BOX 1179 � .; Construction
SOUTHOLD,NEW YORK 11971 tis T
• v Alteration
Telephone ‘y0,y • Are. $10.00 - Residential _,
(631) 765-1800 "l *1P„•.'
�' $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION _
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. =
Fee .$ i
DATE' 3// t/41
APPLICANT NAME: .te--e---�/7�s�
APPLICANT ADDRESS: ,,® Z_
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTR CTION OR ALTERATION: •
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: ?4Lsz <- ..2.l Si-
6 Te-7t002/4-ie_Gf-f/1.,,q,- //co/
OWNER PROPERTY ADDRESS: / 72/5— �nfr /Y/ ei
// q/ /'e77 9'
TELEPHONE NUMBER OF CONTACT PERSON: 4-."--961.-2/
TAX MAP NO. : Section 3/ Block S Lot - •
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Appli nt•
RECEIVED BY:
Town CI rk's Office
DATE: 2•�O/
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Theodore & Mildred Gabel
12215 Main Road
East Marion