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HomeMy WebLinkAboutColombo, Charles , , o�oSUFFot�-� OG ELIZABETH A. NEVILLE � y� Town Hall, 53095 Main Road TOWN CLERK v�a Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O Southold, New York 11971 MARRIAGE OFFICER y�� �0�� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER 1 � `�► Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER t3ISPUSAL PERMIT CONSTRUCTION OR AL?'ERATION PERMIT SEPTIC TANK or CESSPOOL Perm i t No. 3283 R �es�c�e�:ti al x tvo�-�Es��en��al �=ee $ 10.00 s�p�ic x Cesspool ` P�RMIT ISSU�D T0: Name : COLOMBO, CHARLES P. ,4ddre55 1: �. 0. BOX 612 i.ity St Z1p GREENPORT NY �1944 oescripton of Proposed Construc�ion or Rlteraticn '�aE�f CflNSTRUCT�ON �i+.�AL APPROVAL RE�UIRED FROM THE SUF�O�iC COUl�TY HEALTt� DE�ARTMENT �a�ne Of Owner COLON`�BO, CHA�LES p. ------------------------------ Mai�ing Address 1 P. 0. BOx 612 ------------------------------ ------------------------------ City St Zip GREENPORT NY 11944 -------------------- -- ---------- �r�perty Address 1 95 VICTORIA BRIV� ------------------------------ ------------------------------ City St Z1� SOUTHOLD NY 11�71 -------------------- -- ---------- �ax Map tvo. section 780.00 block 9 lat 77.000 ------ --- ------ Crass S`reet �AIN BAYVIE�1 ROAD ------------------------------ �u�id�ng P�rmlt NUmI3�C Cross �eference: ----------------------------------- zssue �ate: 2/10/05 Elizabeth �,. �veville -------- southold Town clerk (�rowr� �Ea�) - � � �2�3 r . � O�OSVFF���C OG ELIZABETH A.NEVILLE �� y� Town Hall,53095 Main Road TOWN CLERK y Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS O � Southold, New York 11971 MARRIAGE OFFICER y • ��� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��l � `1►a Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK JAN 2 5 �' TOWN OF SOUTHOLD TO: Southold Town�uilding Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: January 25, 2005 Transmitted herewith is a copy of application No. 3427 for a Cesspool/Septic Tank Construction Permit submitted by: Charles P. Colombo 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: /Z`��- , Signature D/ �-s— Os'_ Dated . . : ", o�SUFFo�,��,o ELIZABETH A.NEVILI.E h`L` �y Town Hall, 53095 Main Road TOW1V CLE�i,K � � P.O. Box 1179 Z Southold,New York 11971 REGIBTRAR OF VITAL STATISTICS �y. Af MARRIAGE OFFICER ��, ♦ �'� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER � � Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER �'� � �a southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10 or Non-Residential @$25 Application No. ���� Permit No. Applicant Name ��-�R Q-�S � �� ��$� Applicant Mailing Address ��� ��-aC � (� C��=���6?�; 1�(y 1 l R`f � Septic Tank or Cesspool Brief Description of Proposed Construction or Alteration '�i�E� �+��S?TZ..1,tC�lvOJ Location of Proposed Construction/Alteration: Owner of Property: ��l-s�2��� �'- �� � �t ��-, Owner Mailing Address: � O. 8 o x �l � � ���, �ry � t�� Owner Property Address: �S Vtc-�ORt Q �2�u� �''��.Tl�-ct�t�, ►.i`f l ( �'7� Name and phone number of contact person �'�-�� Q �l.o Kt,Prp 7�0,;—�6�f 3 Tax Map No: Section �g Block�_ Lot�� Cross Street �t iJ �A�N i�ic� R�o A-� NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SUR WITH ALTH DEPARTMENT APPROVAL �- Signature of Applicant Date � � Received by: l � � � . s ' � � � � c' ' �j� --�-�,-----�---- � Jtl��l�� � 1—I�Q����� SU�FC��.'K CO!.TF�3''� ��^��.�',�T�rIE�T'4,����L'��'ERVICES � s�-rv�-r�= ���r�w ��. . . � ! � � � N T�l jl`l% J�/V 1 T7V� ��au!'r�"�"�`�1� h�,_iP �1'�,�.QA� �.`��Oi�:h�'�..�t�"'?n"�I�1�+�$'�� �.l�d�, 8..A��,1*�<:��'9t` �+����::1�`,it�.t'�is.� � SUFFOL�G C�OUHTY, 1�lY �A�. � � . , ,�.� �ov-o �8 aw � � E _ �����r i��. o SURVEYED tI-OI-2Q04 ¢ � � SUFFOLK GOUNTY TAX # APA�t`J'V �Ts .c„a,,,_ • 1000-"18-�i-7� �rC31� Cvl b€Jl�Ei�..)F',,,�ai 7 .('ii'vS� `� C,ERTII+IDa 1'O: EJCAiI�S I'�i�EE'���.F'���'���:3�p�"T�CB�A�'PR�VAL = t�srles P.Colo�bo we,, � � = �q' ���/�i,� I d'�a N 9 - s/'� 4� o � ! �V ,?�o "V � q�o or' - we�� ���jy' � erq or� _ � ;'�VI� _ � � �Sf7q r'y - � , _ �` � �,� W �/r��;. � ` � �� � . � � � � - � �� � � 9• A = ` " ' i �N��� '79s - \ ; � �q � _ � �a � '��,,, . , = c p , , � �,;,• �� ��� �' j � ' �. � , _ � L � `.a �r;� �� � p� p �0 �r ,� Uj�� � ;� �p, „ � � [� UO / i� � ,� F � V! � , � � _�%'� !'�o k_ �` a,� � � /� ,'; •o �- �� 0��� �' �'�� � - � .�. , �*�� @�� Q ;- � U m o U �_ � a ,oQ '' �� �� 4� �`� ,; �� �cv '; ,> � � � , � ,s, , , :- ,�, , , � r= �� r ,a , , �c .- �, � � �Q ,,�, � � p � �- � w'`� i � � i � - � � � 0 �\ � 4 �� � O�� o� � \ / ' / � cp i ,' i /i C��� �• �c �� � ';' F?fioposed „ Q � �,, �� � House y �� �O� �� Q� � 2 � �� � i �\ //� 1nD• /'// � � p ^ i: � � - _ \ � '� / . \ ` � '------- - --' -� , � N i --- - - �--- -- � � i � i i �_--'"� . �� � �.� � _ _ `� � � �' �c Q _. 4E� PropoSed 5epttc � � � r n�Qi @,� rn ' 8' dia. 4' deep GP's � a,�� I � so �0 � � " �' Q . : 1V' � �,`�� ' �e ��, . � @` � �'� � ,so a�jjjT,,, �test � _ "�1l� eC9e 93 hole TeSt Hole�p ! �]�,o �F p •�?, � McDonald � �� °�1�� q�e�B�E frr s�.�5� 6eOSGIenGe �� w +���t e I = I 5'