HomeMy WebLinkAboutAdriano, Ernesto I�,IOA.- SO!/lyol
ELIZABETH A.NEVILLE4 Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G ,�� Southold, New York 11971
MARRIAGE OFFICER �O �� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �•‘v, & J II, Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER COUNTY 11Isoutholdtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3443 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ERNESTO A. ADRIANO
Address 1: 723 GREENBELT PARKWAY WEST
City St Zip HOLDBROOK NY 11741
Descripton of Proposed Construction or Alteration
-SINGLE FAMILY DWELLING, SANITARY SYSTEM & WELL WATER
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner ERNESTO A. ADRIANO
Mailing Address 1 723 GREENBELT PARKWAY WEST
City St Zip HOLBROOK NY 11741
Property Address 1 2195 EDWARDS LANE
City St Zip ORIENT NY 11957
Tax Map No. section 18.00 block 3 lot 6.120
Cross Street
Building Permit Number Cross Reference:
Issue Date: 6/08/06 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
��,�%OF SOOjryo
ELIZABETH A.NEVILLE it 4.�O 4 •44 Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
co* Yr Southold, New York 11971
REGISTRAR OF VITAL STATISTICS o* �;
MARRIAGE OFFICER -- _- _ . r Fax (631) 765-6145
RE ORDS IVIANAGEMENT OFFICER L T,f, �.,, Telephone (631) 765-1800
FREE OM OF INFORMATION OFFICER DU ������ southoldtown.northfork.net
. ... 1
MAY 16
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. 3596 for a Cesspool/Septic Tank Construction or
Alteration Permit submitted by:
Erneoto Adriano
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:
APPROVEI.
DISAPPROVE
Comments: ( -44-‘,.
A , -Ac.'"'"--.6
Signature
00)--/OC
Dated
„ ..,,-,
eV
ELIZABETH A.NEVILLE - i'* Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS fs
Southold, New York 11971
MARRIAGE OFFICER : v Fax(631) 765-6145
1
RECORDS MANAGEMENT OFFICER =_,L NO. Telephone Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - ', 4 ��.'' southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRI
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$l0)(or Non-Residential @$25 Application No 511p
Permit No.
Applicant Name ,alf&5'To 4 /8/e/A-AJo
Applicant Mailing Address 723 G SEN.moi ay `
Septic Tank s' or Cesspool
Brief Description o ropofsed�Constructi or Alter tiR116”on SnE '7 Q1�H�
, ott 4.t-4.7
Location of Proposed Construction/Alteration:
Owner of Property: -/cJE tiro '1AcM'4 '
Owner Mailing Address: 7-23 A2Lietv-,77- ,4�y. GU
e �,dO,<' N. 4/ ,i $i/
Owner Property Address: V/95- &"a '4 O5 ZifidE
Q�
7U1/ //937
Name and phone number of contact person
Tax Map No: /000 Section /r Block 3 Lot C./2_
Cross Street
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
(6-)A, .c-//s/6 6
Signature of Applicant Date
Received by:
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