HomeMy WebLinkAboutGellman 1
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ELIZABETH A. NEVILLE h`Z` * Town Hall, 53095 Main Road
TOWN CLERK % to) - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER `` .$. .1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER = "'/Q� $$'�,1 Fax
(631) 765-1800
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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. 3028 R Residential x Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MARTIN GELLMAN
Address 1: 1475 MEDAY AVENUE
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 GELLMAN, MARTIN & FLORENCE
Mailing Address 1 PO BOX 256
City St Zip MATTITUCK NY 11952
Property Address 1 1475 MEDAY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 9 lot 5.000
Cross Street HOWARD AVENU
Building Permit Number Cross Reference:
Issue Date: 5/14/03 Elizabeth A. Neville
Southold Town Clerk
(TowN SEAL)
oil' OFFOL j 3°2 7�
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ELIZABETH A.NEVILLE 1°0 Gym Town Hall, 53095 Main Road
_ TOWN CLERK P.O. Box 1179
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• REGISTRAR OF VITAL STATISTICS :146 47
' Southold, New York 11971
MARRIAGE OFFICER � ,L
�� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y"'/® �a®����1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
ApR 2 270 OFFICE OF THE TOWN CLERK
` TOWN OF SOUTHOLD
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, TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 22, 2003
Transmitted herewith is a copy of application No. 3152 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Martin Gellman
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 1// 64'4/ E' 14€ re,"(4*e'
Comments: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
27/LZ...TV
Signature
2,
Dated
OFFICE OF THE TOWN CLERK '�� D�p�n'
TOWN OF SOUTHOLD �•14 ,1 \1 Ui LQ�I' Application No.
ELIZABETH A.NEVILLE,TOWN CLERK
1641.
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•
P.O.BOX 1179 , ° Construction
SOUTHOLD,NEW YORK 11971 g '�
• 14 1 Alteration
Telephone %=o,��, � � • $10.00 -Residential
(631) 765-1800 -_ . > ‘t; ; $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for A '22Z2-20'03.7
CONSTRUCTION or ALTERATION PERM h° , ' $Y `,1,. -pggir.4.
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$ (' Q , 0(9
DATE A Pi(L 17, l/oD 3
APPLICANT NAME: p&a,--r-w cc tIA
APPLICANT ADDRESS: I 4-z_s". Nth (DAy yQ'II ALU L
/AmriTu v-, N v ),__s-4
SEPTIC _ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
. OWNER OF PROPERTY:
RP FLO ReMcc=
OWNER MAILING ADDRESS: g(7)( \-'(o
1,4A Dr ( ( (Luc- , 1�(�� ( (4i
OWNER PROPERTY ADDRESS: / c os Ft.e---bAy1/la ` t (T"v
TELEPHONE NUMBER OF CONTACT PERSON: - e3"3 70
TAX MAP NO. : Section f I3 Block 9 Lot
CROSS STREET: 1.6GUAI ,4L
BUILDING PERMIT NUMBER CROSS REFERENCE:
' 4111111a
- �;foe:,
Signature/of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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