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OFFOLdr
ELIZABETH A.NEVILLE /�0 V* Town Hall, 53095 Main Road
TOWN CLERK % ® - P.O. Box 1179
ctAREGISTRAR,OF VITAL STATISTICS
Southold New York 11971
Fax (631) 765-6145
MARRIAGE OFFICER
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RECORDS MANAGEMENT OFFICER `= � r 40 ,0 ,
#21 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2956 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GENDOT HOMES
Address 1: PO BOX 534
City St Zip WADING RIVER NY 11792
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 #R10-02-0042
Name Of Owner GENDOT HOMES
Mailing Address 1 Po BOX 534
City St. Zip WADING RIVER NY 11792
Property Address 1 WELLS ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 3 lot 22.000
Cross Street WELLS ROAD
Building Permit Number Cross Reference:
Issue Date: 12/26/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
i, " c;e 1 :?s,.k)
ELIZABETH A.NEVILLE '_� y�; Town Hall, 53095 Main Road
TOWN CLERK % o - % P.O. Box 1179
%REGISTRAR OF VITAL STATISTICS % i Southold, New York 11971
MARRIAGE OFFICER %.`4,%',!i �����, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �_�Ql 4. �a0�i� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER _ �� southoldtown.northfork.net
_ .„,..'�
”. _ - T µ '; '4 OFFICE OF THE TOWN CLERK
`, 32(102: , „i TOWN OF SOUTHOLD
TO":"" ';_' ` Southohl Town Buildi
ng Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 2, 2002
Transmitted herewith is a copy of application No. 3078 for a Cesspool/Septic Tank Construction
Permit submitted by:
Gendot Homes
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: f .1.--2,-, , :ae." ..,40z
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7/7e_e_z_rW/7:5___
Signature
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Dated
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OFFICE OF TEE TOWN CLERK �� ,,,,",•,,� •
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FIIZABETHA NEVI"'TOWN OF SOUTHOLD-P,TOWN LERx es&4 °S�FFOCk�oG_. Application No.367�
P.O.BOX 1179 g •r Construction c/
SOUTHOLD,NEW YORK 11971
n fT.1Alteration
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Telephone ��,f�, �
(631-) 765-1800 Q��•� • $10.00 - Residential
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$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 ///2-7/02-
APPLICANT NAME: • 11/276 /1/6Q-e,
5
APPLICANT ADDRESS: /4) c53'/`•
ilolf/.5: 4/.
SEPTIC ) 'CE'SSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Ali,/ 4%LO-4o/0i,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: .0019Ogie:
OWNER MAILING ADDRESS: PO /fix (.5::-Ty
/4&d// /%C ''; fif
OWNER PROPERTY ADDRESS:
`t. //s /16/ SQ iMin/Kt
TELEPHONE NUMBER OF CONTACT PERSON: 69/-<7.2-57_,K4/0-2
TAX MAP NO. : Section 7O Block Lot eo 2 2-
CROSS STREET: L"7/S /(i
BUILDING PERMIT NUMBER CROSS REFERENCE:
;le/ 2
Signature •' Applicant
RECEIVED BY :
� A
•w Clerk's Office
DATE:
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LOT ArREA= 41,768 sq. ft. ,
I .F. ELEV.= 25.5
GAR. ELEV.= 24.0
LOT NUMBER 13 — VACANT
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S 24'11'10"E 125.01'
(22.2) (22.6)
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20' DRAINAGE EASEMENT'—'
125.00' 1
(23.0) N 23'23'50141 125.00' (22.2)
OAKLAWN AVENUE
existing water main
VACANT
THE OFFSETS (OR DIMENSIONS) SHOWN HEREON FROM THE SIRUCTINES TO THE
PROPERTY LINE'ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE ARE NOT JOB No. 01-617 ALE No. PECONIC DEVEL. CORP.
MENDED TO OWE THE ERECTION OF FENCES. RETAINING WALLS. POOLS. PATIOS.
PLANTING ARF-AS. AOOTIION TO BUILDINGS DR ANY OTHER CONSTRUCTION. SURVEYED FOR
UNAUTHORIZED ALTERATION OR ADDITION 10 THIS SURVEY IS A VIOLATION OF SECTION LOT NUMBER 1
rma OF THE NEW YORK STATE EDUCATION L . MAP OF PECONIC DEVELOPMENT CORP. AT SOUTHOLD
OUARANTTFS MCKIM HERON SHALL RUN ONLY TO THE PERSON FOR WHOM THE
-SLIMY-Na-PREPARED. AND ON HIS BEHALF TO THE TIRE COMPANY. GOVERNMENTAL SITUATED AT SOUTHOLD
AGENCY AND LENDING INSImJTION USTED HEREON. AND TO THE ASSIGNEES OF THE
LENDING INSTOUTONN. GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSIMMONS TOWN OF SOUTHOLD — SUFFOLK COUNTY N.Y.
OR lUESEOUENT OWNERS.
COPIES OF THIS RIMY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL. OR SCALE 1" = 50' DATE 12-20-2001
EIS SEAL. SHILL mar BE CONSIDERED TO BE A VAUJD TRUE COPY.
FILED MAP No. I DATE
CERTIFIED ONLY TO: TAX MAP No. (REF 'ONLY) 1000-70-3—P/022 DISK 500
HAROLD F. TRANCHON JR. P.C.
LAND SURVEYOR
C_/,,,,AF - �>� 1866 WADING RIVER—MANOR RD. WADING RIVER,
— - V NEW YORK, 1T792
N.Y. LIC. No. 048992 631-929-4695
HAROLD F. TRANCHON JR. PENN. LIC. No. 2115—E