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JUDITH T.TERRY � _ Gy�c• Town Hall, 53095 Main Road
TOWN CLERK y = • P.O. Box 1179
$ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ��
MARRIAGE OFFICER
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��� ' Telephone
Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER i ! '�►�od (516) 765-1800
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FREEDOM OF INFORMATION OFFICER .��„ ,••I'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1463 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : BERNA GUVENC
Address 1 : 1014 N. HAMILTON AVENUE
City St Zip LINDENHURST NY 11747
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-96-0007
Name Of Owner BUVENC, BERNA & TERRANOVA, G.
Mailing Address 1 1014 N. HAMILTON AVENUE
City St Zip LINDENHURST NY 11747
Property Address 1 4995 MILL ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 100.00 block 5 lot 2.000
Cross Street OREGON ROAD
Building Permit Number Cross Reference:
Issue Date: 4/18/96 Judith T. Terry
Southold Town Clerk
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JUDITH T.TERRY o < Town Hall,53095 Main Road
TOWN CLERK ti Z P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICSy O� '�/ Fax(516)765-1823
MARRIAGE OFFICER �Q a �I Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER i •1 + i'
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 15, 1996
Transmitted herewith is a copy of application No. 1523 for a Cesspool/
Septic Tank Construction Permit submitted by:
Berna Guvenc and Giacomo Terranova •
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. 6 R
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l5 U L5
Thank you. + l!
APR 161996 !
BLDG. DEPT.
'OWN OF SOUTHOI_D
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: %� '' �� i.Jj/ .) /r' !%c' G' ho
Signature �-
/f 1
Dated
OFFICE OF THE TOWN CLERK .•," " •
Town of Southold �,0"OfOIXop
Judith T. Terry, Town Clerk ��' 1% . G L Application No. ;?_3Town Hall, 53095 Main Road �� - �' Construction
P. O. Box 1179 l o = M
Southold, New York 11971 ;cry , ��• Alteration j
Telephone = � • $10.00 - Residential ✓/
(516) 765-1801 ��,0 $0 ' $25.00 Non Residential
• -,-
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for R
ECIPOW
CONSTRUCTION or ALTERATION PERMIT
lPRi5 "
SEPTIC TANK or CESSPOOL
TO
Permit No.
Fee •$
DATE ivca. 15 -199 Cp
APPLICANT NAME: 7EMR (U,JEr C_
APPLICANT ADDRESS: 1‘311 1\• tIverem0-04 "WE-
1-1 tD Eff kj(2 -T- \V 757
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
5 KV9 LG FA-VW Us/ 'IWEtiNsJC
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: (RDE1Qn114 G11.I•E1C-- A- 11N-GOrYtO [E.1ZgArNICPIA
OWNER MAILING ADDRESS: PIA N ' 1 t YY1lLTJr\ k\JE -
OWNER PROPERTY ADDRESS: cof. 3E12. VleoQEgT' oF
Li 995 ht-te 1 MtL-L LANIE ikOb )4\)t-L. 1-of
TELEPHONE NUMBER OF CONTACT PERSON: 951-6a_AS 9-
TAX MAP NO. : Section 1 00 Block `j Lot oC
CROSS STREET: i,MLL, 1 -NNE - j\._ JM
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Jh5
CbQ1.4 .
Signature of Applica t
RECEIVED BY: •
S
il
C�leri Office
DATE: L1 . 15- ' i 1 •
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SUFFOLX COM' DEPARTMENT OF HEALTH SERVICES
DATEJAN 3 1"
FOR A.P. PRO.VALI:::.,(1.....):ISTAUG`toi::.:ii C
SINCLE F cs 4. I e'AI de d Jan. 1Z 199c
khaki ,'.1.::.: WC
E CIA:LY
APPROVED _. ......A. / 4 -
i F.XPIRES THREE YEARS FPOM DATE C::: ." T-Fia-444—!i_ I