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ELIZABETH A.NEVILLE ��� '� Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS � � �
MARRIAGE OFFICER t� � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � �®1 �®��� 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. 2991 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JENNIFER GANGITANO
Address 1: PO BOX 888
City St Zip ROCKY POINT NY 11778
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 #R10-02-0203
Name Of Owner GANGITANO, JENNIFER
Mailing Address 1 PO Box 888
City St Zip ROCKY POINT NY 11778
Property Address 1 100 SOUTH HARBOR ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 75.00 block 4 lot 30.000
Cross Street ROUTE 25
Building Permit Number cross Reference:
Issue Date: 2/18/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
C 2ek
"1,0004 ---, C79
ELIZABETH A. NEVILLE laS t Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
% ti 2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % V' 1
MARRIAGE OFFICER `�°,fiL � Fax Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER = "'/Ql �a��,' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER���,,��� southoldtown.northfork.net
7:::\r _ L'f?t=-.-A-"- ' I \:i OFFICE OF THE TOWN CLERK
V%) }7----
Yt ` 7^ '` '\ TOWN OF SOUTHOLD
I, � s
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T `1,---- ---Southold town uilding Department
FR Linda J. Cooper, Southold Town Clerk's Office
DATED: December 31, 2002
Transmitted herewith is a copy of application No. 3113 for a Cesspool/Septic Tank Construction
Permit submitted by:
Jennifer Gangitano
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:
.... 4e--(..f:' C...w. ...- --M' - .d'''- - - - -:
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Signature
C9/1/6)3/
Dated
✓moi
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OFFICE OF TEE TOWN CLERK �I������•��•••��;
TOWN OF SOUTHOLD ,��•'OC,uFFOtKcP:•
1 13
FTTlABETHA NEVTT"T"F,TOWN CLERK �� o . • Application No30
P.O.BOX 1179 ;
SOUTHOLD,NEW YORK 11971 rn
Construction
v
Alteration
1-) 765 180
‘‘'b 470.1 4one
70.1 $10.00 - Residential
T(G3 ) 765-1800 - ��
'oly $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE /02 d,
APPLICANT NAME: //if al✓I�l l /16
APPLICANT ADDRESS: / 1j g-Og ��GG
AlifrantWIEZE
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERVTION
s iht l\,,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATIO :
OWNER OF PROPERTY: /th 'L
OWNER MAILING ADDRESS: PON ag
fee 7/14d) .N //776
OWNER PROPERTY ADDRESS: /a) Saj
• c l o lid
TELEPHONE NUMBER OF CONTACT PERSON: (tJ1egi) 7W—W?_7
TAX MAP NO� Block Section 75 J
� � Lot 5O
sBUILCROSS STREET: - _,,,„„g5--
BUILDING
DING PERMIT NUMBER CROSS REFERENCE: rip - 0,72-----94
Si etatur of Applicant
_ 9 pp t
r
RECEIVED BY:
Town Clerk's Office
DATE:
5', ' \ .4 I
.
t
. J
• L&--s-IRUM$ RS REFER TO 'MAP OF MINOR SUBDIVISION OF,.P e, TY
,�UR VEY OF .PR OPER T Y �r " _ SUI i y '"FOR SAL VA TORE CATAPANO' FILED IN THE S&f.��K�- RUNTY
,
CLERIC S - 3FT1cE, ON JUNE 25, 1992 AS FILE NO. 92 !rFOLA CO i
AT SOUT.FIOLD
.�N 2062 OCT 17 Ali10: 15
TOWN OF SOUT�I4 D
" j,EPT OF HEALTh SERVICES
SUFFOLK COUNTY, NEW YORK >�i FiCWASTEWATER TEWATER MG
•1400-75-04-30 Penyhov�es
SCALE: =50 9rweiirg0' +
AUG. 28, 2002 - LOT 3
320,17.
SES...«.w.....M.... .o.......,y....,..�.....�....._...�... . . ..._ .._....
,;;IPPENA:r!O N EA?AP.1111:.ir(*hT4LTHSERVICE:- E STic a_ ts.7
•49`30• a�►
•
iER1' T POZt APT1t+ OVAL OFGON i tfi7CTION FOR A N 79 _
31 �
SINGLE tAMILV RECEDENCE ONLY
• h
,
f DATE ‘.1-30-OD- 05120 .1tiie b---o -0-
tJ
APPROVED -L 1.... -- 6_ is u -kk vs
FOR MAXIMUM OF E► ' • _ UAW • cil
---\
EXPIRES THREE YEARS FROM DATE OF APPROVAL - LOT 1 z
0 1 �
cn °; 4:.
,1 LOT 2 c
• L } A
Q,Ga-ni ' ' 1 n
• i 4 v / A
'1 1
Z4') £ -�
231• __ 4_—-- d
, ce- �� t
0 '�6 ...► P��P f { 75
t of WAY I�
..,......„.........i
2 l "' X30' i N
_ ' ____ 1 R. t ` N
'tet- �' ` `o o p '
cow
v 4
s clI
icy r_ Ey ii.-1. '
n N 34 r T
g 14..*** * y�i B,, 32017'\t 4f NEW
Y
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NOTES: '
of .�
3 11SA
I am familiar with the STANDARDS FOR APPROVAL 730 , **** OOR i 41,,,r,b4
AND CONSTRUCTION OF SUBSURFACE SEWAGE •49,Iv W THE OPEN D t t
• 4 it
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES S 79 CHURCH OF we.- . �' p
and wilt abide by the conditions set forth therein and NCO/F "'E,�i` F�� w,• 4941% Acv
on the permit -to construct, `'h,,c` (P p LAND SV�J
The location of wells and cesspools shown hereon are
.7--q,;,1 N.)'.S. LW. NO, 49618
from field observations and or data obtained from others. PECONIC SVEYORS, P.C.
ANY ALTtRATIUN DR ADDITION TO THIS SURVEY IS A VIOLATION (631) 765 - 5020 FAX'C631) 765-1797
Elevations are referenced to an assumed datum, OF SECTION 7EO9 IF fl/E NEW YORK STATE EDUCATION LAW.
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