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ELIZABETH A.NEVILLE /01 $• Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i, Southold, New York 11971
�� Fax(631) 765-6145
MARRIAGE OFFICER : 1i � �1
RECORDS MANAGEMENT OFFICER "'/Ql 'a®,���,°e 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. 2973 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GARY LAUBE
Address 1: PO BOX 1770
City St Zip SOUTHOLD NY 11971
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 #
Name Of Owner LAUBE, GARY
Mailing Address 1 PO BOX 1770
City St Zip SOUTHOLD NY 11971
Property Address 1 310 ACKERLY POND LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 5 lot 5.000
Cross Street LOWER ROAD
Building Permit Number cross Reference:
Issue Date: 12/26/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
9
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ELIZABETH A. NEVILLE ��j OG1\� Town Hall, 53095 Main Road
TOWN CLERK H - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
MARRIAGE OFFICER ` ,!i ��ot� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � S Ii. Telephone (631) 765-1800
FREEDOM OF INFORMATION O FCER ,,� southoldtown.northfork.net
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ki
N OFFICE OF THE TOWN CLERK
•• E _,_gEG t3�A�002 "'i L TOWN OF SOUTHOLD
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T I: TO" Y,�ix� - oiitlioI1 wn-Building Department
•
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 2, 2002
Transmitted herewith is a copy of application No. 3079 for a Cesspool/Septic Tank Construction
Permit submitted by:
Gary Laube
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 follow'
recommendations: p•
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APPROVE
DISAPPROVE
Comments:
A4targilit>/-
Signature
n2-A7/.2._
Dated
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OFFICE OF THE TOWN CLERK 11.1 �l rucK
TOWN OF SOUTHOLD �' O� COG Application No.,j077
ELIZABETH A.NEVILLE,TOWN CLERK ►
P.O.BOX 1179 !C ; Construction
SOUTHOLD,NEW YORK 11971 t _
o • ^' ; Alteration '
•
Telephone ,y �Qt',, ' $10.00 -Residential
(63t) 765-1800 = xid0 '�� $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /d i ra-/n L
APPLICANT NAME: gckv-ii
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APPLICANT ADDRESS: Q. 0 • f I_ 1 + D 1nw \ I 1 d
SEPTIC I/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 0(..% (--. --
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CON TRUCTION OR ALTERATION:
• OWNER OF PROPERTY: CN. Lc - - --
OWNER MAILING ADDRESS: y, D, PAN- ! oo1' )\ LAI
OWNER PROPERTY ADDRESS: 3 k) cl\-4 Y 19 fro LC'Ivy
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TELEPHONE NUMBER OF CONTACTOPERSON: t"�S-- (DIOS
TAX MAP NO. : Section I 0 Block 5 Lot S
CROSS STREET: LOVJ-C-11 11-x\
BUILDING PERMIT NUMBER CROSS REFERENCE: j t 3
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Sig ature of Applicant .
RECEIVED BY:
Town Clerk's Office
DATE:
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ACKERLY P OND LANE
(BOWERY LANE) -
-
��sEs P PROPOSED SEPTIC SYSTEM DETAIL
(NOT TO SCALE)
-
HOUSE
DWELLING 11.s
(WELL OVER 150') I FINISHED GRADE FINISH GRADE
l ELEV. 10.0' 7
ELEV. 9.1'