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Home My WebLink AboutDeSimone, Scott (3) , suFFoc,�'0G- ELIZABETH A.NEVILLE ti � Town Hall, 53095 Main Road TOWN CLERK CO P.O.Box 1179 y Southold,New York 11971 REGISTRAR OF VITAL STATISTICS t MARRIAGE OFFICER I, Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �:y�Qjgg l 4:00.� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 4258-R Residential X Non-Residential Fee $ 10.00 New X Existing Name Of Owner DE SIMONE, SCOTT Mailing Address 1 41780 ROUTE 25 Mailing Address 2 City St Zip PECONIC NY 11958-0000 Property Address 1 41780 ROUTE 25 Property Address 2 City St Zip PECONIC NY 11958-0000 Owner Telephone No. 631-765-3535 Tax Map No. section 86.00 block 1 lot 7.000 Cross Street INDIAN NECK ROAD Issue Date: 8/06/04 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) ,•,iii.. f0 \ ELIZABETH A. NEVILLE ` Town Hall,53095 Main Road TOWN CLERK 4 Ai P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Pft � Southold, New York 11971 MARRIAGE OFFICER Fax(631) 765-6145 7 RECORDS MANAGEMENT OFFICER O � Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER 6l #0.0 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION OPERATION PERMIT CESSPOOL or SEPTIC TANK Residential @$10or Non-Residential @ $25 Application No. % Permit No. 113 I9 Owner Name c'� t'r v l satcrrt4r. Owner Mailing Address StI 780 Pec.D, e /rg05 Owner Property Address tr/04-' Owner Telephone No. 61 --76 1"3 s3 Tax Map No: Section et., Block ( Lot Cross Street ►��ta�n �/�,t,� U�.. Please check each that applies: New Construction �� Alteration to Existin System Residential Non-Residential NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. (Locate building and system; give north arrow and approximate distance in feet from system to building and closest road. New construction may submit copy of survey with SCHD approval.) ellbOtt Signat e of • 6 0 licant Date Received by: It‘0004 AN. ELIZABETH A.NEVILLE 41G't,,� Town Hall,53095 Main Road TOWN CLERK "� • P.O.Box 1179 REGISTRAR OF VITAL STATISTICS M �� Southold,New York 11971 MARRIAGE OFFICER � � Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER - O,' #41•• Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICEResoutholdtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD January 29, 2004 Scott DeSimone 41780 Main Road Southold,NY 11971 RE: SCTM# 86-1-7 Dear Sir: Enclosed herewith is the Construction, Alteration or Modification Permit for a Septic Tank/Cesspool System for which you applied. AFTER the system is installed but prior to being used, an OPERATION PERMIT IS REQUIRED. The operation Permit is issued by the Southold Town Clerk's Office. The fee is Ten Dollars ($10.00) for a residential system and twenty-five dollars ($25.00) for a non- residential system. Your check should be made payable to the "Southold Town Clerk". An application form is enclosed. Please complete the requested information and return the application, proper fee, and LOCATION MAP (map must indicate the location of the cesspool(s)/septic tank(s), giving approximate distances in feet from any buildings to the pools and distances between the pools. Should you have any questions concerning this matter, please do not hesitate to contact this office. Very truly yours, yr \ Lynda M Bohn Account Clerk Enclosures I rs FO,,,,C ELIZABETH A.NEVILLE 04# 'ld`M Town Hall, 53095 Main Road TOWN CLERK ; y a $ P.O.Box 1179 REGISTRAR OF VITAL STATISTICS V o �� Southold,New York 11971 MARRIAGE OFFICER .fr �. Fax Fax(631) 765-6145 RECORDS MANAGEMENT OFFICERIAGE Alp OFFIC (631) 765-1800 FREEDOM OF INFORMATION OFFICER ,�� southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 3113 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : SCOTT DESIMONE Address 1: 41780 MAIN ROAD City St Zip PECONIC NY 11958 Descripton of Proposed Construction or Alteration ADDITION TO EXISTING SYSTEM. APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTINO REQUIRED. R10-03-0118 Name Of Owner DESIMONE, SCOTT Mailing Address 1 41780 MAIN ROAD City St Zip PECONIC NY 11958 Property Address 1 41780 MAIN ROAD City St Zip PECONIC NY 11958 Tax Map No. section 86.00 block 1 lot 7.000 Cross Street INDIAN NECK LANE Building Permit Number Cross Reference: 47.kACe74640 Issue Date: 1/29/04 Elizabeth A. Neville Southold Town Clerk - .11\ N.1- y iffy ) ` '-o - ') v • . • c• --�j��j I1``1 • \N e o 0 OE Ol ° ,/ro 0 �L'INVO\C v,Pj�� O vo isre g�• 8 O et ` lP V\ v ` 1 �J o ?,..��V.C< • y. v •' • P �� • 5 CON°O,Ap11 55•A5 9 • • EE OF P /0R W\R6 5 N v 4-� ° •. va / cf) ^ v . ',•( P - N Iv • o • V. • 410----Uj„�.- C) OD • v ,, �/ 'J v / v N. V I • 455 ' Ncf v m • m . f rri . v 1 \ . v ‘ \t% 1 •_ cn • ( 74”. >3 �p1lFS ,+11 F \ lE ti$ SE•M►K .&1J orn. 1.). C ,r- r, • D s h Z �SPW�T WAS •�/'_ w� w Z : 4 cw�vE� �'' .o b. 1. Z A t W n (+ (J1 �j �n 24.5t. ?tib•• rn ° � " v tot ay o COO �S v % WwE�5'1..,/�1 . 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MON. 11 "' (98.75 5 48 (g 48 .29„WDEED) RESERVED AREA D tirS 46' A9 SUBDIVISION MAPT pECONIC" sse «RICHMOND SHCRES A CLERK OF SUFFOLK COUNT'( FILED IN THE OFFICE OF THE AS FILE No. 6873 ON NOVEMBER 20, i