HomeMy WebLinkAboutMello, Chad 60,ki
sop 4
•
B % Town Hall, 53095 Main Road
1�1 oe Obi P.O. Box 1179
Southold, New York 11971
���
JUDITH T.TERRY TELEPHONE�����.�• 516> 765-1801
TOWN CLERK
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1582 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CHAD D. MELLO
Address 1 : 1529 FLANDERS ROAD
City St Zip RIVERHEAD NY 11901
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. SCHD REF. #R10-96-108
Name Of Owner MELLO, CHAD D.
Mailing Address 1 1529 FLANDERS ROAD
City St Zip RIVERHEAD NY 11901
Property Address 1 BAILIE BEACH ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 2 lot 4.013
Cross Street SOUNDVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/20/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
0.0
�,,�OFF°I,�c �-
�r 0, p�.
JUDITH T.TERRY ����� y1. Town Hall, 53095 Main Road
•
TOWN CLERK y x • P.O. Box 1179•
•
REGISTRAR OF VITAL STATISTICS
Southold, New York 11971
MARRIAGE OFFICER 4:* 0.1► Fax(516)765-1823
RECORDS MANAGEMENT OFFICER � $ 01 Telephone(516) 765-1800
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: December 16, 1996
Transmitted herewith is a copy of application No. 1650 for a Cesspool/
Septic Tank Construction Permit submitted by:
Chad D. Mello
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 1.
DISAPPROVE
Comments: 1 74,,,, JCd' o—
RECEIVED
DEC 2 0 1996 Signatuf.2641-
10/> S .L
Southold Town (nr1:, Dated
OFFICE OF TME TOWN CLERK
Town of Southold ,,''"., 00tKC'
Application No./6/5-6
Town Clerk
Judith T. Terry, "-4
Town Hall, 53095 Main Road ; Construction L/
P. O. Box 1179 Alteration
Southold, New York 11971 . ,'
Telephone ,f ,oe4 $10.00 - Residential !/
p
(516) 765-1801 = �1 4� ,, ' $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 e.eernber 1 1-0_, I qq C.Q
APPLICANT NAME: Chad b• 1 -LI
APPLICANT ADDRESS: 15x9 PI and-er5 (
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
nn e
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: .Chad D M e.. 1 ( d
OWNER MAILING ADDRESS: L5C I 1-1 anile 3 Rd •
N -\J . \ tqO I
OWNER PROPERTY ADDRESS: Ea. 1 I I��Ccsh
Ma-i4 i u C SN . \ . i I gam.
TELEPHONE NUMBER OF CONTACT PERSON: .8/„Qq-5- 5.914
TAX MAP NO. : Section 79 BlockO3 Lot 44 , 1 3
CROSS STREET: "Da tared V ie,vv Ave .
BUILDING PERMIT NUMBER CROSS REFERENCE:
_ --h0`. -6r) -Miller-
a � -rner -
Signature of Applicant
RECEIVED BY: l' /
Town Clerk's Office
•
'Potronot, 1 SUFFOLK coauv v cepArrhatrr ar i31041.1V111111VICII
I
:_':;.tMrt'fog Af'1 OVAL oir CONINIKOCION.fnaA
tt 'JG...h.--1
/ }.
salt f 1.;N V'i .. i 1956 Hi MI.No., ,t,'41 4,24 /a
/✓Gd-/6 ,7oE / ( /,
-rit „�:a S' .1 00-,,,t:t+ii,b4 OF 4_, . .,,
• * 111.A
-19 -EXPIRES THREs YEARS FROM t ►T$ .
kivii
,iS
Q
1 {0(rj.0 Q d
oAtl01..5 0 f
A .
N 004 40' ; L' 'r -f
•t 451 +,�,•_
4V ,r
W
3 3 00 � 3
, \► .W
a2.�c ......
•
N1- +1 Iscr//[{J
L ��
tu3.o Iii. -Tid- 441,L
47 (alb' 18 -3or.J 125. Da \ ,,.
rjq.5 - O5144 ewr '..d."046017 _ i'2•.9 { ,
A4Wi4Avt' ••'M.! ,Iuo.4 I.i.. *A� 1 -061+ C
i ______ _. __ .
i YY,,.:12z .'7C-'S.._ _ _!‘.✓ . .",i'I' GE '
-rA x Lon atur- I ;,.„-!',. '.'r', 1 r# . . :r .:'•i.3.....111.)8 1)A 13,13115g
\/a4+.1 ' lFFOLK COUNTY DEPT. OF ______
• THE WATER SUPPLY$.SEWAGE _
:'7.:;: •` HEALTH SERVICES FOR
DISPOSAL FOR THIS REST
WILL CONF Olvt'TO APPROVAL.OF CC &T ONLY
iH::X11_iii J- --DA_TE'-.=_ , ...-,.R •,;',., ••,,,. ...,„,,�) e I '
M, ,REF PCO. ...........o.
COPT OF A -� APF't `1�_ M....�...�. =
-n, rim,- A...r MnA> w.+ ." -. .�,..... ..