HomeMy WebLinkAboutPavone, Christopher 1
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SCUTHCLD VIASTEIMTER ISI SPCSAL PERM T
OCNSTRJCTI CN CR ALTERATI CN PERM T
SEPTI C TAMC or CESSPOOL
Per m t Nb. 4182 R Rosi dent i al X Nbn-l f si dent i al
Fee $ 10. 00 Septic X Cesspool
PERM T I SSIED TO
Nan e : GARY TABOR
Address 1: 680 NAVY STREET
a t y St Zi p CR ENT NY 11957
Cescr i pt on of Proposed Const r uct i on or Al t er at i on
ACO TI CN TO EXI STI N3 SYSTEM
APPRCWED AS SLUM TTED Mal NTAJ N RECD RED SETBACKS FICAA ADJACENT
WELLS, EU LDI NCS, PROPERTY LI NES AND MATER BCD ES.
Nana a Omer PAVCNE
Mai I i ng Address 1 560 Vl LLACE LANE
Qty St Zip CR! ENT NY 11957
Pr oper t y Address 1 56 \A LLAC E LANE
a ty St Zi p CR ENT NY 11957
Tax Map Nb. section 25. 00 bl ock 1 I of 11. 000
a oss Street Mal N ROAD
Bui I di ng Per m t Minter Q-oss Ref er ence:
I ssue Dat e: 2/21/ 14 B i zabet h A Nevi I I e
Sout hold Tows a er k
Alk
OFFO(,t
ELIZABETH A.NEVILLE,MC e„$•• Co
Mr/y Town Hall, 53095 Main Road
TOWN CLERK p P.O.Box 1179
t H Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS v'
O �` Fax(631)765-6145
MARRIAGE OFFICER 0*,0' Telephone(631)765-1800
FREEDOM ORECORDS F INFORMA ION OFFICER AGEMENT OFFICER Ol ,0." www.southoldtownny.gov
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD DEC 2 7 2013
TO: Southold Town Building Department
FROM: Carol Hydell, Southold Town Clerk's Office
DATED: December 17, 2013
Transmitted herewith is a copy of application No. 4182 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Gary Tabor for Christopher Pavone
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. Thank you
* * * * * * * * * * * *
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.
Signature
0//3//1
Dated
oft SVFOL/r
ELIZABETH A. NEVILLE tet �4 Town Hall, 53095 Main Road
TOWN CLERK ' P.O. Box 1179
REGISTRAR OF VITAL STATISTICS w Southold, New York 11971
MARRIAGE OFFICER 'F 1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER .y4 a0�'o Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - '1 �' 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. f /
Permit No.
Applicant Name
Applicant Mailing Address FcC, >/ S
Septic Tank !or Cesspool
Brief Description of Proposed Construction or Alteration
Location of Proposed Construction/Alteration:
Owner of Property: gi:t 6 e 'I r
Owner Mailing Address: 55490 V 'Ilai �- /
Ori
Owner Property Address: ,y 1 0 11I nal R.)
OrieAed—
Name and phone number of contact person 6-"9 1- y 3' 3 ---g G 7
Tax Map No: 1000 Section ;AT- Block 0 Lot I I
Cross Street thio" i►.N 1 -
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
--- ��/17113
Signature of Apt Date
Received by:
• I.
GARY TABOR
Excavating/Landscaping/Coal
Navy Street
Orient, New York 11957
( b6) 323-2667
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