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ELIZABETH A.NEVILLE ',`y` Gym; Town Hall, 53095 Main Road
TOWN CLERK ; ti P.O. Box 1179
Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax Fax (516) 765-1823
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MARRIAGE OFFICER t #-v %\' Telephone (516) 765-1800
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RECORDS MANAGEMENT OFFICER *as�
FREEDOM OF INFORMATION OFFICER 6l
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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. 1849 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HARRY P. BIFULCO III
Address 1 : 151 LANDING MEADOW ROAD
City St Zip SMITHTOWN NY 11787
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 #R10-97-0030
Name Of Owner BIFULCO, HARRY P., III
Mailing Address 1 151 LANDING MEADOW ROAD
City St Zip SMITHTOWN NY 11787
Property Address 1 4730 OAKLAWN AVENUE EXT.
City St Zip SOUTHOLD NY 11971
Tax Map No. section 70.00 block 9 lot 49.000
Cross Street CLEARVIEW AVENUE
Building Permit Number Cross Reference:
41440 ft4d4
Issue Date: 4/29/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE $,`Z y �� Town Hal], 53095 Main Road
TOWN CLERK ; y -4 , P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • v'
O * Fax (516) 765-1823
MARRIAGE OFFICER : ifi
RECORDS MANAGEMENT OFFICER �l �a0 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ��
"2z_cr yI,I
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 23, 1998
Transmitted herewith is a copy of application No. 1923 for a Cesspool/
Septic Tank Construction Permit submitted by:
Harry P. Bifulco •
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.
Thank you.
�c-dw
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
Signature
Dated
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OFFICE OF THE TOWN CLERK Sy�FoA'c"
Town of Southold - � cy 3
Judith T. Terry, Town Clerk w.. Application No.
Town Hall, 53095 Main Road -� Construction
P. O. Box 1179 $ Alteration
Southold, New York 11971 ' *t- ✓-
Telephone '7701 Alt 1� '� Residential
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(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 Y/V9g
APPLICANT NAME: AM9 * jJ�,,ct^
APPLICANT ADDRESS: /5) 1,1444D,,t,C., P44axAJ �D
5M R,.n ,ti ilJ y ))R7
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Reela-c-s--9 Ian C--fgr
(2-) 2 x (1.
LOCATION MAP: Must be attached hereto before permit may be issued. / Zge6.
LOCATION OF PROPOSED CONSTRUCTION OR ALTRATION:
OWNER OF PROPERTY: F �
OWNER MAILING ADDRESS: �A = ,Qt ,pyo
OWNER PROPERTY ADDRESS: I70 O u,,, � �� E
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TELEPHONE NUMBER OF CONTACT .PERSON: ��y�y{dcag9
TAX MAP NO. : Section 70 Block 9 Lot Z/9
CROSS STREET: it g-
BUILDING PERMIT NUMBER CROSS REFERENCE:. ZYW9h
/Lin?
ign ture.f Applicant
RECEIVED BY: 7
1 Clerk's Office
DATE: tiZ /Y
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SUFFOLK CO_HEALTH DEPT.APPROVAL
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