HomeMy WebLinkAboutEsposito, Marie JUDITH T. TERRY � Town Hall, 53095 Main Road
TOWN CLERK o T •
P.O. Box 1179
to Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘VA, Fax (516) 765-1823
MARRIAGE OFFICER �0 �t' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER cub
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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. 1216 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MARIE ESPOSITO
Address 1 : 170 CHARLES STREET
City St Zip EAST WILLISTON NY 11596
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. #86-5-3
Name Of Owner ESPOSITO, MARIE
Mailing Address 1 170 CHARLES STREET
City St Zip EAST WILLISTON NY 11596
Property Address 1 KIELBASA ALLEY
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 5 lot 3.000
Cross Street INDIAN NECK LANE
Building Permit Number Cross Reference:
Issue Date: 10/13/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. /TERRY Z Town Hall, 53095 Main Road
TOWN CLERK : p T P.O. Box 1179
gis •• Southold, New York 11971
REGISTRAR OF VITAL STATISTICS VO �. �� Fax (516) 765-1823
MARRIAGE OFFICER ,�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER =�'�/ •
•
FREEDOM OF INFORMATION OFFICER #10°-�
OFFICE OF THE TOWN CLERK [ il ; 1
TOWN OF SOUTHOLD
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TO: Southold Town Building Department exp
FROM: Linda J. Cooper, Southold Town Clerk's Office 7. 657-3 c
?VV: OF
DATED: September 22, 1994
Transmitted herewith is a copy of application No. 1260 for a Cesspool/
Septic Tank Construction Permit submitted by:
Marie Esposito -
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: 6'ajzo ��ic .” E6
Signatu e
/a/d/9-fi
Dated
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OFFICE bF THE TOWN CLERK ,c.0FO(,,`,'
Town of Southold 0., DG
Judith T. Terry, Town Clerk � . Application No. �oL��)
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Town Hall, 53095 Alain Road o Construction -�
P. O. Box 1179 u. �� _
Southold, New York 11971 �• Alteration
Telephone
N
r [ 00 Residential ��
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: %/2/ 74'-----:-C- ' s `/
APPLICANT ADDRESS: /-7-d (2,yr! S Sr
4-----.95-7- (_ ,//:_1-7.0-,-2 , ,evy /.45-N„
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
A/ (4.) U A Fi4 m I L y TJ Lc) E L C 1 iv 6--
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:'
OWNER OF PROPERTY: /VOW/( - . . cm* �
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OWNER MAILING ADDRESS: /c- t!) --57—
q _ L✓/7/s70)-7 /1/y- //SW-
OWNER PROPERTY ADDRESS: �'
eiE- ,BAS A tgLL
TELEPHONE NUMBER OF CONTACT PERSON:�s/6) --202-3
TAX MAP NO. : Section 7.p Block 5— Lot 3
CROSS STREET: -- ' /c)14,A/ 4A/ /?bA
BUILDING PERMIT NUMBER CROSS REFERENCE:..
Signa -e of Applicant
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RECEIVED BY: '1 ,
A .
iown Clerk's Office
DATE: C
9" 1- /'
, SUFFOLK CO. HEALTH DEPT. APPROVAL .
643.95 - , --- -.
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SUFFOLK CO; PT.gspEA Ll.....15ER VICES.
0 I , APPLICANT
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0 SUFFOLK COUNTY DEPT. OF HEALTH
_ PQOP. , " SERVICES - FOR APPROVAL OF
POOLS '
CONSTRUCTION ONLY
DATE: JUL 24 W.
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