HomeMy WebLinkAboutAdriano, Erneoto
ELIZABETH A. NEVILLE
TOWN CLERK
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
REGISTRAR OF VlT AL STATISTICS
" MAR..I!IAGE,OF.FICERc-':c:-,
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FREE i~W dtmli:dRwATION OFFICER
,i MAY I 6, J.',
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TOWN CT' SQU,:i0LD
(>FFICE OF THE 'TOWN CLERK
I TOWN OF SOUTHOLD
TO:
Southold Town Building Department
FROM:
Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3596 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Erneoto Adriano
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
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I have reviewed the application and location map ofthe project cited above and make the following
recommendations:
APPROVE
/
DISAPPROVE
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Signature rtJ
CJ6~~Ab
Dated I {
EUZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 63096 Main Road
~ P.O. Box 1179 .
SouthoJd, New York 11971
Fax (631) 766-6146
Telephone (631) 766.1800
southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @~or Non-Residential @ $25 _
Application Ng~
Permit No.
Applicant Name Eiwm70 A 11;o,el/l-JJo
Applicant Mailing Address 723 4ee~/J~ 'lkaJl/ to.
fIoL/OR4?/l, Ai. V II? "'I
Septic Tank~orCesspool~ ';\ . )/
Brief Detption 0 ropo ed Construct! or AlteIltion ~I1E fO;t.( I L '/ \Jp.I~/IIf~
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Location of Proposed Construction! Alteration:
Owner of Property: G:12/JE. ~ TO /! /1J)/b A->>o
Owner Mailing Address: '1:23 4~~l:3a:r~v /().
M>! S~o/<, jJ. VI; '7 y./
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Owner Property Address: ~/q5" K~WA,I!.,{)5 <-n7V
o III EVT ;tJ. if 1/~S7
Name and phone number of contact person
Tax Map No: 1000 Section / f'
Cross Street
Block .3
Lot b. /L
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH REALm DEPARTMENT APPROVAL
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Signature of Applicant . Date
Received by:
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SUFFOLK COUN'lY DEPARTMENT OF HEAL TIl SERVICES
g....l PERMIT FOR APPROVAL OFCONSTRUcrrON FOR A
SINGLE FAMILY RESIDENCS ONLY
DATB <f/l:i.o6 SREF.NO. Ri~~~-OLJr
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ill . R MAXIMUM OF..t.... B DROOMS
~ EXPIREs 1lIRBE YEARs FROM DA TB OF APPROVAL
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; EXCAVATION INSPECTION REQUIRED
FOR SAN Af';;! rEM
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