HomeMy WebLinkAboutGerosa • t000k,sioes,07:r,iiTot..1,;;;.\.
ELIZABETH A.NEVILLE ��� x 'V _ �� Town Hall, 53095 Main Road
TOWN CLERK ; t `g. P.O. Box 1179
REGISTRAR OF VITAL STATISTICS etto Y 'r � ;w �� Southold, New York 11971
MARRIAGE OFFICER : ���$ Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =_�®4/ ,�22,,` t o/ Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER .z r' ���
OFFICE OF THE TOWN CLERK
SOUTHOLD ivowN mosTsgitr taffS)SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2709 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.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner GEROSA, ILLIAM
Mailing Address 1 134 PALMER AVENUE
City St Zip SLEEPY HOLLOW NY 10591
Property Address 1 515 CIRCLE DRIVE
City St Zip EAST MARION NY 11939
Tax Map No. section 21 .00 block 3 lot 3.001
Cross Street AQUAVIEW DRIVE
Building Permit Number Cross Reference:
Issue Date: 12/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE iii�� t ' Town Hall, 53095 Main Road
. - % P.O. Box 1179
TOWN CLERK % ® ,�. � �,�: � �
t ;�: i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • t ,,-, ,,. 0�
MARRIAGE OFFICER '':%t... Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `\-714. ,,, ��®�i��, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,s' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK 4 E?� � W
TOWN OF SOUTHOLD
DEC S.3.POI
TO: Southold Town Building Department BLDG.DEPT. ''
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 12, 2001
t
,. Transmitted herewith is a copy of application No. 2805 for a Cesspool/Septic Tank ALTERATION
t Permit submitted by:
Peconic Cesspool for Gerosa
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. .
IF
o / ,
Signature
/1,1-/-147 7
Dated
OFFICE OF THE TOWN CLERK 1.1. �FFOLk
TOWN OFBOUFHOLD �� cJ �'QG= Application No.
ELIZABETH A.NEVILLE,TOWN CLERK ,' v
P.O.BOX 1179 � Construction
SOUTHOLD,NEW YORK 11971t
v • Alteration
ifs
Telephone ,j' $10.00 - Residential Sr-
(631) 765-1800 = �1' o' $25.00$25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION . RECEIVED
Nrt
for
DEC 1 2 2001
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL Southold Town Clerk
Permit No.
Fee .$
DATE
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. O. BOX 972
MATTITUCK, NEW YORK 11952 '
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALT RATION:
. OWNER OF PROPERTY:
OWNER MAILING ADDRESS: /3 Ret-44. � ai-e-
,j —e f /J 1fr /v5 9/
OWNER PROPERTY ADDRESS: S/5 D-i
/1L4,ezi--4 I/9 3 y'
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section 14 Block 3 - Lot 3 i
CROSS STREET: -
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Atiplicant
RECEIVED BY:
Town Clerk's Office
DATE: •
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William Gerosa
11.1 ,011 515 Circle Drive
East Marion
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