HomeMy WebLinkAboutChristiano, Cheryl SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3956 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : COASTLINE CESSPOOL & DRAIN SRV
Address 1: 4225 BRIDGE LANE
City St Zip CUT CHOGUE NY 11935
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner CHERYL CHRISTIANO
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Mailing Address 1 1140 DEEPHOLE DRIVE
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City St Zip MATTITUCK NY 11952
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Property Address 1 1140 DEEPHOLE DRIVE
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City St Zip MATTITUCK NY 11952
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Tax Map No. section 115.00 block 12 lot 16.000
------ --- ------
Cross Street RICHARD STREET
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Building Permit Number Cross Reference:
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Issue Date: 5/26/10 Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
SO!/r'yo
ELIZABETH A. NEVILLE,RMC,CMC '�� l0 Town Hall, 53095 Main Road
TOWN CLERK l�i [ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS N Southold, New York 11971
MARRIAGE OFFICER �O Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER 2 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �UNT`I,� southoldtown.northfork.net
OFFICE OF THE TOWN CLER E C E D U E
TOWN OF SOUTHOLD D
MAY 242010
TO: Southold Town Building Department
BLDG.DEPT.
TOWN Of SOUTHOLD
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 24, 2010
Transmitted herewith is a copy of application No. 956 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Coastline Cesspool & Drain Service for Cheryl Christiano
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me.
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells, buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
s"
Signature
`14e
Ig
Dated
ELIZABETH A. NEVILLE �`1`� �Gy Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
:
REGISTRAR OF VITAL STATISTICS v. � Southold, New York 11971
MARRIAGE OFFICER Oy �� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER O'� �a southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
3
Residential @ $10 r or Non-Residential @$25 Application No.<�
Permit No.
Applicant Name�„�� a'e'-sC�E
Applicant Mailing Address
Septic Tank s-- or Cesspool
Brief Description of Proposed Construction or Alteration G�
Location of Proposed Construction/Alteration:
Owner of Property: ��4x,✓� �'Itfr.�.✓o
Owner Mailing Address: ,/.r= /��_
Owner Property Address:_
Name and phone number of contact person' /r//,�,�,�
Tax Map No/�D Section //S Block /j Lot /6
Cross Street��r _S
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH PARTMENT APPROVAL
Signature of Applicant Date
Received by:
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SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4418-R Residential X Non-Residential
Fee $ 10.00 New Existing X
I
Name Of Owner CHERYL CHRISTIANO
\AY-44�
------------------------------ �, Q
Mailing Address 1 1140 DEEPHOLE DRIVE
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Mailing Address 2
City St Zip MATTITUCK NY 11952-0000
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Property Address 1 1140 DEEPHOLD DRIVE
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Property Address 2
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City St Zip MATI'ITUCK NY 11952-0000
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Owner Telephone No. 000-000-0000
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Tax Map No. section 115.00 block 12 lot 16.000
------ --- ------
Cross Street RICHARD STREET
------------------------------
----------------------------------
Issue Date: 8/02/10Elizabeth A. Neville
-------- Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE �� y< Town Hall, 53095 Main Road
Cz
TOWN CLERK W P.O. Box 1179
REGISTRAR,OF VITAL STATISTICSO � Southold, New York 11971
NS RFax (631) 5
MANAGEMENT OFFICER �� �aO�� Telephone (63 6
-6145
RECORD765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
OPERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @ $25 Application No.�J
U
Permit No. g 5lO ►�
Owner Name C-A e iii L CLir�s �i o
Owner Mailing Address 11410 e e p I-lo L e P.- ve
&1-rT-1 �vc 2-
Owner
Owner Property Address
Owner Telephone No. �lO 31
Tax Map No: Section /IS, 00 Block /a Lot 16 , O o 6
Cross Street 2 c a.,cy/ e �
Please check each that applies: New Construction
Alteration to Existir g System
Residential ✓ Non-Residential
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate
building and system; give north arrow and approximate distance in feet from system to building
and closest road. New construction may submit copy of survey with SCHD approval.)
tore of Applicant Date
Received by:
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