HomeMy WebLinkAboutDomino, Michael • �� 011,.WFO(,'
JUDITH T.TERRY 1• Town Hall, 53095 Main Road
TOWN CLERK ► ti Z P.O. Box 1179
v. t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS (516) 765-1823
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MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER : * #0.01 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER "
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1448 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MICHAEL AND JOY DOMINO
Address 1 : P. O. BOX 151
City St Zip SHOREHAM NY 11786
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. #R10-96-0014
Name Of Owner DOMINO, MICHAEL AND JOY
Mailing Address 1 P. O. BOX 151
City St Zip SHOREHAM NY 11786
Property Address 1 3590 OLD NORTH ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 2 lot 25.004
Cross Street MT. BEULAH
Building Permit Number Cross Reference:
Issue Date: 4/09/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY ` = 1 t Town Hall, 53095 Main Road
TOWN CLERK ti Z P.O.Box 1179
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REGISTRAR OF VITAL STATISTICS
0 ,�� Southold,New York 11971
MARRIAGE OFFICER =/le a �� Fax(516)765-1823
RECORDS MANAGEMENT OFFICER .� * +00 d Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER _ . psi'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 18, 1996
Transmitted herewith is a copy of application No. 1507 for a Cesspool/
Septic Tank Construction Permit submitted by:
Michael and .Joy Donimo
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
� 9
9
Comments: '" 5C� e— ' /6, o - '—o°/Y
RECEIVED
APR 9 1996
Signat
Town Clerk Somthdd 4_
Dated
OFFICE OF THE TOWN CLERK ,,," •
Town of Southold fa `l'�
Judith T. Terry, Town Clerk +" �$ `. Application No. /007
Town Hall, 53095 Main Road ; ,, Construction
P. 0. Box 1179 w Alteration
Southold, New York 11971
Tele hone / '� $10.00 - Residential r/
P
(516) 765-1801 - l tt $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 3-I$ q �O
APPLICANT NAME: UY\ i (JAQ2I . 4 J Det' "b"0m IAO
APPLICANT ADDRESS: i/ ( c I
h o (Via-k✓l
•
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: •Must be attached hereto before permit may be issued.
LOCATION OF PRkPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: f 1 I c.k O\ e ( \r1 D
OWNER MAILING ADDRESS: 43 1 .-1
OWNER PROPERTY Ara RESS: J 69-
0 kvt N
TELEPHONE NUMBER OF CONTACT PERSON: `7L/4- 0 /
TAX MAP NO. : Section dS S Block c LotV;i5Z S* L
CROSS STREET: yy\ 1361 uk_C C�
BUILDING PERMIT NUMBER CROSS REFERENCE :
Signet r of Applicant
•
RECEIVED BY; l ` '(
Town Clerk's Office '
DATE: f 8 9,6
u III I I 1 1 1111 11.11111.JHu lml,wJ a 111 I HIH 111 Id u I Id I „ ,
/. _ SUFFOLK CO. HEALTH DEPT. APPROVAL
• `ice w �y' , / •• �`I, ._ _ `R._.._._ .
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4.. H. S. NO.
• �-! 1 UIZVEYED P
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OF HEALTH SERVICES ! "ftp �� .._ i +'t- f
SUFFOLK COUNTY DEPARTMENT ..'-
! STATEMENT OF INTENT - !
PERMIT FOR APPROVAL OF CONSTRUCTION FORA �� - ,•-••, (_. r� C
} SINGES FAMILY RESIDENCE ONLY • �.,'•• t. �k'; L,rTl-t;..t,. J4Y r' THE WATER SUPPLY AND SEWAGE DISPOSAL
• b-�6 ►o��! !� ` j``v' ;_ �.` T SYSTEMS FOR THIS RESIDENCE WILL- I
DATE FEB 2 2 HS REF. , r I / / •
�. CONFORM TO THE STANDARDS OF THE i
f `! . A i , • 0 SUFFOLK CO. DEPT. OF HEALTI-t:=SERYlCE5.
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APPROVED �� / f f se C !Z..' _ •
5)
FOR MAXIMUM OF HEDR•a Etet-'" 7.�M '1,-• l ADPL 1 CA NT
EXPIRES THREE YEARS FROM DATE OF APPROVAL ;' :,; ~'5 ` ,
,.. ._ i2Z3-0 SUFFOLK COUNTY DEPT. OF HEALTH-
,,, .: ,�,� � , r }� SERVICES — FOR APPROVAL .FOR
- T. . 1 r _ - CONSTRUCTION ONLY
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NOTES: ._ I DATE:
+ SES 35. .--- _ --r, t�Q
I,FROPE:"�rY C !.!.4; t / L. ,,,/,k-030.
�(j f `'--.,� H. S. REF. IYO..
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MAP *� k 3/4'r411L:,Y :.3,BQt"c,'�:l. -� --,,�_ `�`�"ik: F •. `ti ..
- N. '`"- .r c- SUFFOLK CO:TAX MAP DESIGNATION:
'SEA LEVEL. ^ `L �• ' { f
DIST. SECT. BLOCK .PCL.
.3:SUFF COTAX-MAP DATA; tom-055-2-PA,2.5. ,• /
f - ,o-• \ � •
IOUQ: 0755 Z P
o. '` '�'� f OWNERS ADORE55:
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t '
40 t 4! 1
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1 ;� t �u i DEED: L-73.85 -_P_..�55 (2EFt.
WATER SrIIPPLY AND SEWAGE DISPOSAL SYSTEMS MIIST - ' U „".`'""';."'"' 'Of "Q"
/ f TEST klC}4E b «� •
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