HomeMy WebLinkAboutCioffi SCUTHCLD VIASTEVIl1TER DI SPCGAL PERM T
CCNSTRIJCTI CN CR ALTERATI CN PERM T
SEPTI C TANK or CESSPCCL
Per rri t Nb. 4380 R Resi dent i al X Wn-Resi dent i al
Fee $ 10. 00 Sept i c X Cesspool
PERM T I SSUED TO-
.Name M KE CI CFFI
Address 1: 47 CHESTNUT AVENLE
CI t y St Zip EAST SEI AUKET NY 11733
Dascr i pt on of Proposed Const r uct i on, or AI t er at i on
SAN TARY SYSTEM FCR SI NCiE FAM LY DIELLI NG
APPROJED AS SUSM TTED AND AS APPROJED BY THE SUFFCLK CCUVTY DEPARTMENT
CF HEALTH SERUI CES. FI NAL APPROVAL FEW RED-FRCM THE SUFFCLK CCLKN
HEALTH DEPARTMENT. REF #R10- 16-0013 NPJ NTAI,N 50 FT STBACK FRM REAR DCK
Narre CF CAner YCUNG JA PARK
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Wi I i ng Address 1 3595 ELI JAH LAM
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Ci t y St ,Zi p NATTI TUCK NY 11952
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Property
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Property Address 1 3595 ELI JAH LAM
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Ci t y St Zip MATTI TUCK NY 11952
Tax Mbp fib.- sect i on 108. 00, block 4 1 of 7. 210
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Cross St r eet SCUD AVENUE
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Bui I di ng Per rri t Nurrber Cr oss Ref er ence:
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Issue
---------------------------------Issue Date: 4/21/ 16 0 i zabet h A Nevi I I e
-------- Sout hold Town d erk
(TOIN SEAL)
ELIZABETH A.NEVILLE,MMC may® r/y Town Hall,53095 Main Road
TOWN CLERK ® P.O.Box 1179
H Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631)765-6145
MARRIAGE OFFICERy
RECORDS MANAGEMENT OFFICER ®,l .�a® Telephone(631)765-1800
www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ® V
DD
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TO: Southold Town Building Department APR 1 5 2015
FROM: Sabrina Born, Southold Town Clerk's Office
BUIL DING DEPT.
DATED: April 15, 2016 TOWN OF SOUTHOLD
RE: Cesspool Construction Application
Transmitted herewith is a copy of application No. 4380 for a Cesspool/Septic Tank Construction
Permit submitted by:
Mike Cioffi for Young-Ja Park
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. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Final approval required from the-Suffolk County Health Department.
Coll
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Signature
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Dated