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JUDITH T. TERRY ; : Town Hall, 53095 Main Road
TOWN CLERK Z O T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
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MARRIAGE OFFICER 1' Fax (516) 765-1823
_ 741 � .0> •�� Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1058 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ANGELO ACCARDO
Address 1 : 85 FORCE LANE
City St Zip CORAM NY 11727
Descripton of Proposed Construction or Alteration
CESSPOOL SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #93 S0-74.
Name Of Owner BRIENBACK, DONNA
Mailing Address 1
City St Zip 0000
Property Address 1 NEW SUFFOLK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 15 lot 1 .000
Cross Street THERESA DRIVE
Building Permit Number Cross Reference:
Issue Date: 11/10/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL1
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JUDITH T. TERRY ' : Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS . Southold, New York 11971
MARRIAGE OFFICER �Q O� �� Fax (516) 765-1823
#2I.1 �1D r� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building DepartmentNOV
_
FROM: Linda J. Cooper, Southold Town Clerk's Office.
DATED: October 29, 1993
Transmitted herewith is a copy of application No. 1089 for a Cesspool/
Septic Tank Construction Permit submitted by:
Angelo Accardo for Donna Brientback (contract vendee) •
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: Ja �j S0 -��,G
4 - Signature
14, '+'J Dated 4A;
441
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OFFICE OF THE TOWN CLERK _ OC\;f-E: ,�
Town of Southold C, ` ‘•O�-
Judith T. Terry, Town Clerk 4; 1 -(1.:.,L-. ..
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�_r" (•-� `'.:. Application No. / 6
Town Hall, 53095 Main Road •
C .`i., ii.1.f..- +�
P. O. Box 1179 �' �': F14-0.1„.•� r;, Construction
Southold, New York 11971 ' '�'
O `i, Alteration
Telephone '°l i7a �b tv Residential
(516) 765- 1301 . „�v
Non-Residential
TOWN OF SOUTHOLD•
.
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
•
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
• DATE /O 2y"fj
APPLICANT NAME: •16/1r.„ , 4C‘4,04- 6
APPLICANT ADDRESS: _.1
laiZCt- ,4g.(.�
Ca/Coe-01 44.. /1 2 7
PTIC ESSPOOL
CRIPTIO PR•POSED CONSTRUCTION OR ALTERATION
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SJJac
LOCATION MAP: Must be attached hereto before
permit may be issued.
LOCATION OF PROPOSED CONSTRU TIONNRR
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OWNER OF PROPERTY: _ - ALTERATION:
t',..-,v,9 it/f 4-/,a4C'
•
• OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: .LI- &i,k /14" re (
TELEPHONE NUMBER OF CONTACT. : 73 - -27fr-27 f
TAX MAP NO. : Section //Jr Block /S .
Lot /
CROSS STREET: 7e - rfi ,(.:
BUILDING PERMIT NUMBER CROSS REFERE
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• Signature of Applicant
RECEIVED BY: i
Town Cleric's Office
DATE:
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' E ,OF S.4 J.'77 ' 8Ye>>TENJ
Suffolk County bept. of Health Services
for approval of construction only
OCT 1 ?
Date ~�' H S Ref. No. 93 So ?'
•
Approved 5 ,i "7 ' ' , _ FAMILY*:Yl g .Y
If- Cei / / � n:ilE$TWEE YEARS Mil DATE CF£iPPROVAL
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NOTES:
2Z C.2EEK,EST. a 1.THE EXISTENCE OF RIGHTS OF WAY AND OF
EASEMENTS OF RECORD,IF ANY OTHER THAN
,5 N`)• 4256, g Iy a SHOWN ARE NOT CERTIFIED.
t' J o 2.THE OFFSETS OR DIMENSIONS SHOWN HEREON,
til N FROM THE PROPERTY LINES TO THE STRUCTURES,ti ;ea
c= ARE FOR A SPECIFIC PURPOSE AND USE,THERE-
�Efrt/ YORE
FORE THEY ARE NOT INTENDED TO MONUMENT
p if, N G THE PROPERTY LINES OR TO GUIDE THE EKG-
/.47-E:SE,o2;/9,/993 Pla
TION OF FENCES,ADDITIONAL STRUCTURES,OR
ANY OTHER IMPROVEMENT.
3.SUBSURFACE STRUCTURES, 1
A.0PL/C4/vT: NOT VISIBLE OR READILY
�NG -4O Ac-r-,4'e'o i APPARENT,ARE NOT SHOWN
85 A-C.Ie EL4. AND THEIR LOCATION AND
(.5� 9 8741-8703 CO/2.41/1,7,A./. .: EXTENT ARE NOT CERTIFIED.
.