HomeMy WebLinkAboutD'Ambrosio, Louis t .
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : p rZ P.O. Box 1179
to � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO s �� Fax (516) 765-1823
MARRIAGE OFFICER /� �� ,� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ' .�(/` 4 'I
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. 1065 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : LOUIS J. D'AMBROSIO
Address 1 : 59 WASHINGTON AVENUE
City St Zip PATCHOGUE NY 11772
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. # 93-SO-78
Name Of Owner D'AMBROSIO, LOUIS
Mailing Address 1 59 WASHINGTON AVENUE
City St Zip PATCHOGUE NY 11772
Property Address 1 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 11 lot 22.000
Cross Street HOWARD AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/01/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
...-3 FULK�O�;
/6) 6 f
JUDITH T. TERRY z Z .G : Town Hall, 53095 Main Road
,I 0O T Box 1179
TOWN CLERIf I P.O.,
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER =%0�' 3
� %lir el Fax Telephone(516)765
6) 21801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 10, 1993
Transmitted herewith is a copy of application No. 1097 for a Cesspool/
Septic Tank Construction Permit submitted by:
Louis J. D'Ambrosio .
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(5-a /, ,�L
Comments: ,5` 93-3O-7fye..i-pe-s___ ..,-
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OFFICE OF THE TOWN CLERK , '�,
• . Town of Southold CN.,) -!: �(, `-
Judith T. Terry, Town Clerk r""` ..
Town Hall, 53095 Main Road � J.i � �. Application No.17 .
P. O. Box 1179 [.c., Construction
Southold, New York 1 1971 �,
�`` :-R-7:), Alteration
Telephone '`-'// Vi �b4 Residential
(516) 765- 1301 . „rev
Non-Residential
.
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEIVATER DISPOSAL DISTRICT
APPLICATION
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•
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CONSTRUCTION or ALTERATION PERMIT •
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 3 3
APPLICANT NAME: Lo�13 Tr
APPLICANT ADDRESS:5-- Lam ,
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
do n.)'- GTI N - IC `1-
LOCATION MAP: • Must be attached hereto before permit maybe issued.
ssued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
' OWNER OF PROPERTY: C
0.,i rS z>_ 10 .
• OWNER MAILING ADDRESS: 5c'.
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OWNER PROPERTY ADDRESS:
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TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block
—__Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
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mature of Applicant
RECEIVED BY: NJ / e
Town Clerk's Office
DATE: %//2z1
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EXPIRES THREE YEARS FRO;;,DALE OF APPRO'Rt i'
SURVEY FOR
LOUIS J. D'AMBROSIO a DEBRA A. D'AMBROSIO '
SUFFOLK COUNTY DEPARTMENT OF HE/LTM Irt,FC4
AT MATTITUCK DATE. SEPT.29,1993
FOR APPROVAL OF CONSTRUCTION ONLY TOWN OF SOUTHOLD SCALE: I 40'
OPTqSUFFOLK COUNTY, NEW YORK NO 93-0747
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