HomeMy WebLinkAboutLicata, Nat ,.. I ,ii/iii
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LIZABETH A.NEVILLE j� Gy�: Town Hall, 53095 Main Road
TOWN CLERK y Z ; P.O. Box 1179
u• i Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS �
MARRIAGE OFFICER . `. g� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '�Ol •,����et.� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3140 R Residential x Non-Residential
Fee $ 10.00 Septic x Cesspool
PERMIT ISSUED TO:
Name : NAT LICATA
Address 1: 1018 OCEAN AVENUE
City St Zip BAYSHORE NY 11706
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR ONE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-03-0159
Name Of Owner LICATA, NAT
Mailing Address 1 1018 OCEAN AVENUE
City St Zip BAYSHORE NY 11706
Property Address 1 695 RYDER FARM LANE
City St Zip ORIENT NY 11957
sax Map No. section 15.00 block 4 lot 8.000
Cross Street UHL LANE
Building Permit Number Cross Reference:
Issue Date: 2/13/04 Elizabeth A. Neville
Southold Town Clerk
(TOWN c!. i,
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ELIZABETH A.NEVILLE or=�0 Gy Town Hall, 53095 Main Road
TOWN CLERK y Z ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� Southold, New York 11971
MARRIAGE OFFICER �fi, !�'1� Fax(631) 765-6145
o
RECORDS MANAGEMENT OFFICER =, 701jig #0,r��• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
`-t6 3 04 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 3, 2004
Transmitted herewith is a copy of application No. 3277 for a Cesspool/Septic Tank Construction
Permit submitted by:
Nat Licata
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments:
l�G
Signature
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Dated
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ELIZABETH A.NEVILLE ��04\ Town Hall, 53095 Main Road
TOWN CLERK isAi P.O. Box 1179
Southold New York 11971
REGISTRAR OF VITAL STATISTICS ' '
MARRIAGE OFFICER O � �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �=y0D�i�� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER ' �a."isoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @ $10 vi or Non-Residential @ $25 Application No. 3217
Permit No.
_ 1
Applicant Name )Q I, I
Applicant Mailing Address 1 C' I C3 0,, F f f, V
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: - — ' —) '` =- i t _ • ti'
Owner Mailing Address: do C -- Q
g\j .� ,( Ay'Shaa�.
Owner Property Address: E q s- y
c Q e✓( {�n1
Otte v\k
Name and phone number of contact person 6/1-
Tax
l Tax Map No: 1 Section ( Block [ Lot Vd
Cross Street j\(\I,-- La.v\Q
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
0-zt a/ / i•-(
nSi Signature of Applicant Dat
Received by: /WAIL)t�/n"„` � pP
SURVEY OF LOT 6I
MAP OF ORIENT BY THE SEA, SECT I ON Thl0UM � e
FILED OCTOBER 26, I616I FILE No. 3444
SITUATE: ORIENT
TOWN: SOUP-OLD
SUFFOLK COUNTY, NY
SURVEYED 10-23-03
SUFFOLK COUNTY TAX # N
1000-15-4-S / r
CERTIFIEDTO: ��°
W � � E
NAT L]ICATA ��
JUDY LI[CATA
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NOTES: `"+, � ' us '>,"
1P RES THREE YEARS�OtEO /, .:' (L , `
MONUMENT ` Py W �rA
PARCEL RESIDES IN ZONE DISTRICT R-40 \�\2) V. (f\0\' ato Lhe° oLr.nds on Ne� , So \F only
or vr��5rerm eo tn, go pr evor
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(SETBACKS BASED ON NON CONFORMING LOTS)
Y
ELEVATIONS REFERENCE SUFFOLK COUNTY TOPO MAPS
JOHN C. EHLERS LAND SURVEYOR
AREA = 22,500 sf or 0.516 acres 1'
6 EAST MAIN STREET N.Y.S.LIC.NO. 50202
GRAPHIC SCALE 1"= 30' RIVERHEAD,N.Y. 11901
369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\03-282.pro
- - n/13!2003 195251, \V4 savwbWto5b3-]6]pro q,, i