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.
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Mai�ing Address 1 P. 0. BOx 612
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City St Zip GREENPORT NY 11944
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�r�perty Address 1 95 VICTORIA BRIV�
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City St Z1� SOUTHOLD NY 11�71
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�ax Map tvo. section 780.00 block 9 lat 77.000
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Crass S`reet �AIN BAYVIE�1 ROAD
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�u�id�ng P�rmlt NUmI3�C Cross �eference:
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zssue �ate: 2/10/05 Elizabeth �,. �veville
-------- southold Town clerk
(�rowr� �Ea�)
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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
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Signature of Applicant Date
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Received by: l
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