HomeMy WebLinkAboutBradley, John JUDITH T.TERRY t�� y< • Town Hall, 53095 Main Road
TOWN CLERK ; y Z P.O. Box 1179
��� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax Gy _%:!' Fax Fax (516) 765-1823
MARRIAGE OFFICER O
RECORDS MANAGEMENT OFFICER 491 Alig $9„..° Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1418 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PETER DENICOLA
Address 1 : 1695 CHABLIS PATH
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-95-71
Name Of Owner BRADLEY, JOHN AND IRENE
Mailing Address 1 2700 OLE JULE LANE
City St Zip MATTITUCK NY 11952
Property Address 1 1450 MILL ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 107.00 block 1 lot 2.004
Cross Street GRAND AVENUE (REEVE ROAD)
Building Permit Number Cross Reference:
Issue Date: 11/21/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/rII,O�OSUFF0��AO. / C147(
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JUDITH T.TERRY , Town Hall,53095 Main Road
TOWN CLERK C co, Z % P.O.Box 1179
REGISTRAR OF VITAL STATISTICS t v . Southold,New York 11971
MARRIAGE OFFICER Fax(516)765-1823
RECORDS MANAGEMENT OFFICER -- * �►•01. Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER .,,•, .4'1
OFFICE OF THE TOWN CLERK �� ��'� ' _
TOWN OF SOUTHOLD
, 14 Igg5
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 1 472 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter DeNicola .
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE , '/ ,�
Comments: 1_,U/-' �»-i c-r?:� gl/
Gr /a --??' 7/
/ 4
Signature
// /6 -
Dated
OFFICE OF THE TOWN CLERK ,.,""""••.,
Town of Southold ��' �FFD1.KC
Judith T. Terry, Town Clerk • , . Ol/y; Application No. / 417
Town Hall, 53095 Main Road � Zi._ K: -41
Construction
P. O. Box 1179
ri
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Southold, New York 11971 testa ; ••
Alteration
Telephone ��,j�, �Q��•• $10.00 - Residential
(516) 765-1801 - � * �, ' $25.00 - Non-Residential
• i� , , „/
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE NO0 L ( rich
APPLICANT NAME: re---6 e(\ti CdlC•.
APPLICANT ADDRESS: vi,eic t✓I�a�,LiS �a'�
Sou.41^4LO 101, 1 Irn
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Qs ?e v- (`�-�.S. 0&14.0 a 4424 Ilk
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 4. r to rTe-ere 6eatCe l
OWNER MAILING ADDRESS: 42'7O0 c 1 "Slt-Le La
(1/V444A U.c k t cit
OWNER PROPERTY ADDRESS: / tI5 /7), 1/ �.
TELEPHONE NUMBER OF CONTACT PERSON: `Vo'S --Sie
TAX MAP NO. : Section /6"? Block i' Lot .:::2,1"/
CROSS STREET: 6 y_D___ (Je C -'eve gO)
BUILDING PERMIT NUMBER CROSS REFERENCE:ig9k
Signature of Applicant
RECEIVED
•w, Clerk's Office
DATE: REC'EI �•
NOV 1 4 1995
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„
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,ruFFoGK Co uv �+'�� reRvrNAY s fir.Eo: /rrAWcu /fez•/ J0<FIcA Gou/ yf/c.E"I.: yzo3oAr�A0A S.C. DEPT.OFGv/a,e '786Govcy ro:Rse' 0 HEALTH SERVICES ✓O NN G• gWEy
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see r s OHO °* �T f PLEASE NOTE
ONNeF- � �0 LPr Minimum distance between wells. .�'o,s•� '�'F''
• S --- �� and cesspool is to be 150 feet. �. .uQ'�A
APA',CAW T JOHN G- ST.04.6Ey
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TEST HOLE �^ DONALD G. DEKENIPP
DA riO TAKiN FRO'. i.rao°F , Mi Tr 8- 0 N-�,. //'S=
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