HomeMy WebLinkAboutSpiciarich, John •
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ELIZABETH A. NEVILLE ���_� Gy •
Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
�� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� Fax(631) 765-6145
MARRIAGE OFFICER tel,
RECORDS MANAGEMENT OFFICER y_"'/Ql �a� i��' Telephone (631) 765 1800
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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. 2348 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN & MARILYN SPICIARICH
Address 1 : 1065 BAY AVENUE
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-00-0094
Name Of Owner SPICIARICH, JOHN & MARILYN
Mailing Address 1 1065 BAY AVENUE
City St Zip EAST MARION NY 11939
Property Address 1 980 BAY AVENUE
City St Zip EAST MARION NY 11939
Tax Map No. section 31 .00 block 8 lot 15.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 6/20/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
0361 r
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ELIZABETH A. NEVILLE ���= G'j4%; Town Hall, 53095 Main Road
TOWN CLERK ` O - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �' Southold, New York 11971
� Fax(631) 765-6145
MARRIAGE OFFICER ?i �1
RECORDS MANAGEMENT OFFICER �Ql � Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ W ,sal
'�. . .•S�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 19, 2000
Transmitted herewith is a copy of application No. 2436 for a Cesspool/
Septic Tank Construction Permit submitted by:
John & Marilyn Spiciarich
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:
Si ature
612ofOb
Dated
4
OFFICE OF THE TOWN CLERK COFOUr ""
TOWN OF e..--
ELIZABETH NEVILLE SOUTHOLD
OWN CLERK • ����O CSG►: - Application No.� �
$10.00 Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 0 qF$ $25.00 - Non-Residential
Telephone �'4 * 1 .
Y1��-
(516) 765-1801 -
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE 6/14/00
OWNER NAME: JOHN & MARILYN SPICIARICH
OWNER MAILING ADDRESS: 1065 BAY AVE
EAST MARION NY 11939
V)
OWNER PROPERTY ADDRESS: BAY AVE
EAST MARION NY 11939
OWNER TELEPHONE NUMBER: ( 631 ) 477-8356
TAX MAP NO. : Section 31 Block oR Lot 15
CROSS STREET: W/S BAY AVE 950 ' S/0 MAIN ROAD
TYPE OF SYSTEM: Septic Tank X New X Existing
Cesspool X New X Existing
Residential X Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
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RECEIVED BY: // ALA-A-4,--e----
/_/ Town Clerk's Office
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