HomeMy WebLinkAboutPerrone, Frank (2) o
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ELIZABETH A.NEVILLE e Town Hall, 53095 Main Road
TOWN CLERK 1 * ; P.O. Box 1179
va y� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS G aC
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER .1(1, i$•, Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER . DU + 0 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. 3357 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : FRANK & PATRICIA PERRONE
Address 1: 130 LEXINGTON COURT
City St Zip HOLMDEL NJ 07733
Descripton of Proposed Construction or Alteration
3-4 BEDRRa4 SINGLE FAMILY DWELLING
-FINAL APPROVAL REQUIRED FRCNI THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner FRANK & PATRICIA PERRONE
Mailing Address 1 13 LEXINGTON COURT
City St Zip HOLMDEL NY 7733
Property Address 1 405 RICHMOND ROAD EAST
City St Zip SOUTHOLD NY 11971
Tax Map No. section 135.00 block 3 lot 2.000
Cross Street C.R. 48
Building Permit Number Cross Reference:
Issue Date: 9/28/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ,�let - Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR,OF VITAL STATISTICS y. Southold, New York 11971
MARRIAGE OFFICER %: O t � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER \ /1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� * ,•4:001 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. 3ti U
Permit No3 .-)
Applicant Name 1:1:4=?-. """/ q�e7•1 / Q¢r ( C / Ur c)r,Q-.
Applicant Mailing Address /3 Le----‘e i,-19-t--(=)') r-
/c:)/
/ / )/J 0 7 3 3
Septic Tank or Cesspoolee.c2i r oorym
Brief Description of Proposed 9nstruction or Alteration 3 - t/ aikr
Sl ncc1e_ 6-4/tA_XP / .
Location of Proposed Construction/Alteration:
Owner of Property: k o r-1 o
Owner Mailing Address: / 3 9 u✓4-
lvf e /. ^�T O --� ,33
Owner Property Address:
i9 -7 /
Name and phone number of contact person --33
Tax Map No: Section 1 Block 13 5 cp 2-
Cross Street ) .. or d> C J2 2
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
_ -
Signature of Applicant Date
(260
Received by:
W ,
•�,� �pFS0(,i
ELIZABETH A. NEVILLE • ,O lQ ,4 Town Hall, 53095 Main Road
TOWN CLERK it
* 4,; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS tk N Southold, New York 11971
%MARRIAGE OFFICER G �Q�1�� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �����. ```` �•� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER -CQUN�,``����� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK --".'`,1�\_ �
TOWN OF SOUTHOLD R n V �'i\;
tE. _
TO: Southold Town Building Department `4 `�, A. , 3 Lv3
FROM: Linda J. Cooper, Southold Town Clerk's Office ',F'' :':
DATED: July 13, 2005 '------
Transmitted herewith is a copy of application No. 3488 for a Cesspool/Septic Tank Construction
Permit submitted by:
Frank & Patricia Perrone
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: c-.. ..‘ eirz."-2441-4.--- --t-e-
-2,-,,,.(4-
Signature
IV / /
____
and will abide by the conditions set forth therein and on the t
,
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'r,i ' ga. A ihelie Iso ,s,saidworair
'N permit to construct. TOWN1000:35::0201
The location of wells and cesspools shown hereon are I f SUFFOLK COUNTY, /
from field observations and or from data obtained from others.
Elevations referenced to N.G. V.D.
i . 4e,
-o SCALE. 1'3=30'
ANY ALTERA170N OR ADDITION TO THIS SURVEY IS A VIOLATION - --Z 4P7E1113ER 9, 2004
OF SECTION 7209 OF THE NEW MoRk STATE EDUCATION LAW. t it ..tlosi.,..
i FEBRUARY 14, 2005
EXCEPT AS PER SECTION 7209—SUBDIWSION 2. ALL CERTIFICATIONS 4, .N4..-e.. .N:\0,14%)..
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF t k -N.:-, 44. tri np mo- 9, zo42.5(re....,..4•.)
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
lics ..„, 0,1 MO7 /S. 1.1.0 5 (wey ,,,,. )
WHOSE SIGNATURE APPEARS HEREON. Aillr t i '*#4::Vdk
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES - , ‘s%
(,74*s- IC6'. 1/4S`4 git,
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PERMIT POR APPROVAL OF CONSIMICTIONFOR A
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