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ELIZABETH A. NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK p .. P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 0 ',� Southold, New York 11971
MARRIAGE OFFICER � Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER y'*0 Vt��I, Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER 1'
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1822 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DIANE HEROLD
Address 1 : P. O. BOX 884
City St Zip WESTHAMPTON BEACH NY 11978
Descripton of Proposed Construction or Alteration
REPLACE/UPGRADE EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner AGOGLIA, FLORENCE AND GERARD
Mailing Address 1 2270 EAST 74TH STREET
City St Zip BROOKLYN NY 0000
Property Address 1 6105 PECONIC BAY BLVD
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 10 lot 25.000
Cross Street BIRCH DR./BRAY AVE.
Building Permit Number Cross Reference:
Issue Date: 3/13/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVII.LE I1 t Town Hall, 53095 Main Road
TOWN CLERK %
c:,
-� P.O. Box 1179
Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % v' i
MARRIAGE OFFICER �Oy �*- # Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER ��l *700°
7 �I Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ���
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OFFICE OF THE TOWN CLERK 13
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: March 12, 1998
Transmitted herewith is a copy of application No. 1896 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Daine Herold for Florence and Gerard Agoglia •
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
f"f"j '"<--
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE - ✓
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
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Date
L
' ' O FHCE"OF THE TOWN CLERK c.0FO(kC
Town of Southold OQ Application No. g
Judith T. Terry, Town Clerk "cf" �� -
toTown Hall, 53095 Main RoadConstructiontfl
P. O. Box 1179
Alteration
Southold, New York 11971 --------
Telephone i 0) ,' Residential
(516) 765-1801 ' Non-Residential------
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE _ YVl( s_CK__-/0 2 98 __—.
APPLICANT NAME: I Ps0E RECWL'n- L iZC,1��c -------- - -- ---
APPLICANT ADDRESS: P a 16O1c_8 --- - -- - - --.._.------- --- -
__wEs7��aCil-___..uf. __Yata--I 7.8------------
SEPTIC x CESSPOOL �-
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION eGRAD6
----_ tACE __ E__-EXL SEAG S&ULTE _ YSrEm_._I_s.RL 0LES Tfto v6._
D_C-ef8Ltt 7Q_R.EStx.7_1dL
---_-5eelte. 7Aroi ANom___2� 8� 1�(A4MLt&. .1�__��� fl 4EA Kt`Iti_PezoS ____---
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY : LpgUCE AO) 6C-ILAVID
OWNER MAILING ADDRESS:_ZZZo_-..C� 7_._. _
OWNER PROPERTY ADDRESS: Cc 105 pECout e BAY____f±:pu uAR
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section ma Block _ AD Lot Z5
CROSS STREET : 1367W �3i(Z�H jZaU 1 aP-_-_ARa Y___At.ag_tE__ ----_-----
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY :
Down Clerk's Office
DATE: 11 lqf
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APP ) ED AS NdTEO hyo
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DATE: GC7 4.- B.P. /" •
FEE: 4. '-- 'Bt dolli-/..3„'. ,54,. . _.4...1
NOTIFY ; I ZING DE ,, ' T . -9
761 -1802 9 AM TO 4 PM FOR TH Do !GG
FOLLOWING INSPECTIONS: * ado' Q
1.. FOUNDATION • TWO REQUIRED _ . . . . _ _ _
FOR POURED CONCRETE -
2. ROUGH - FRAMING & PLUMBING
3. INSULATION •
4. FINAL : CONSTRUCTION MUST SURVEY FOR
8E COMPLETE FOR C.0 FLORENCE FITZPATRICK
ALL CONSTRUCTION SHALL MEET G
THE REQUIREMENTS OF THE N.Y. -
STATE CONSTRUCTION & ENERGY TOWN OF SOUTHOLD
GoDFS, NOT RFSPONSIBIE FOR SUFF, CO., N.Y. GUARANTEED TO;
.DES lG odor, CONSTRUCTION ERRORS „ , SOUTHOLD SAVINGS BANK
SCALE: I =4O SECURITY TITLE & GUARANTY CO.
NOTE: MAY 26, 1964
M= MONUMENT /
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PROFESSI ENGR AND
LAND SURVEYOR, N.Y.S. LIC. NO. 12845
RIVERHEAD, N.Y.