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Home My WebLink AboutConstantine, Emanuel r � pG SOUTyoI ELIZABETH A. NEVILLE O Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR OF VITAL STATISTICS N Southold, New York 11971 MARRIAGE OFFICER • �O Fax (631) 765-6145 RECORDS MANAGEMENT OFFICERl Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER �coulm,� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERT SEPTIC TANK or CESSPOOL Permit No. 3372 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : WELLMOD HOMES CORP. Address 1: 21 E. AMBER LANE City St Zip WADING RIVER NY 11792 Descripton of Proposed Construction or Alteration -NEW SEPTIC SYSTEM -FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT Name Of Owner EMANUEL CONSTANTINE ------------------------------ Mailing Address 1 38 STARLIGHT DRIVE ------------------------------ ------------------------------ City St Zip CCHM�SACK NY 11725 -------------------- -- ---------- Property Address 1 385 EAST ROAD ------------------------------ ------------------------------ City St Zip MATTITUCK NY 11952 -------------------- -- ---------- Tax Map No. section 106.00 block 3 lot 11.000 Cross Street INLET DRIVE ------------------------------ Building Permit Number Cross Reference: ---------------------------------- Issue Date: 10/04/05 Elizabeth A. Neville -------- Southold Town Clerk (TOWN SEAL) ,. hOF SO(/jyol ELIZABETH A. NEVILLE 4 Town Hall, 53095 Main Road TOWN CLERK P.O. Box 1179 REGISTRAR,OF VITAL STATISTICS G Q Southold, New York 11971 MARRIAGE OFFICER Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �l�' Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER C�Ui� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: Transmitted herewith is a copy of application No. 3519 for a Cesspool/Septic Tank Construction Permit submitted by: Wellmod Homes Corp. 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: Signature 1 (04 oel Dated ELIZABETH A.NEVILLE TOWN CLERK ~ G�� „Town Hall, 53095 Main Road P.O. Box 1179 REGISTRAR,OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER Gy '� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �f� ��` Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER 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 @$25 Application No. Permit No. Applicant Name WeNMOA t'o*45 COSP- _ Applicant Mailing Address Law-, Septic Tank ✓ or Cesspool Brief Description of Proposed Construction or Alteration_ I�eW See�;�+ 3ug�e rw pe„� se'D -ts Location of Proposed Construction/Alteration: Owner of Property: Ercia,Avek C& S6.y1kjY Z Owner Mailing Address: 3e� Siqd N*.t \Dr �oMM �c off' 11-725 Owner Property AddrAW> GqSf ?o?A W6AC, ► 3It 952- Name 52Name and phone number of contact person EMO-Ave\ CDO.A '\W 631• -��*� Tax Map No: Section 1e ,co Block 83,00 Lot 611 ,C6 Cross Street Tn(2k '044z NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL Si tur Appl' ant Date Received by: �� f I LINGMI7'N A SURVEY OF � T '�3 LLIIYG ii✓IH SUFFOLK C ��IrU CKIC C� Nf Rel'( AT MA ren VA7'�" hELL TOWN Off" �"C� '` �"` :��D � lop Jt' —U Ali: � f SUFFOLKCOUNTY, NEW YORK 100(0 — 106--Q3-11 XNE 13, 2002 . ASTBOAD cl- Sas, LF S S �QB'3f1' E , b S,00' PW 31.r �WU eat �N � � \f�� ot•v 0c , S'T TWr HOLE r OL 4Akre" kmw saw fo, n -• T� . TH SERV ICES fad &own FDA-ML\" UNTX 0�.AjjTM'ZNT ..I' AP MOAN" FOR A' r 177 ,tik J �.-LP— �t1.FL�A.a'Y Nt,•..ri��S.1�•..as INSPECTION nREQIif D ►3• R ly Al APPROVM k--" Ake FUR NIAmUm OF.. gXPtREs r SARsor�DATE OF APPROVAL. 91 L lir [ am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SURWRFACE SEWAGE aISPOSAL SYSTEMS FOR 91*iCL.E_FA►MILY RESIDENCES asap A £i. Ar and will abide by the corhiitJtart$ yet forth therein and ,✓ NEW w :)n the permit to construct. M wEtLlnii I> �r x, IC VA TW) ,. I PtIFS ` LDT The location of wells and ces9poots shown hereon are (VACANT) From field observations and or Cjata obtained from others, 1c. 4 I