HomeMy WebLinkAboutBlados, Tony F04
ELIZABETH A. NEVILLE ��`1` .f ; Town Hall, 53095 Main Road
TOWN CLERK p -� P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR,OF VITAL STATISTICS v. N�
MARRIAGE OFFICER �
Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER ��y�f O� �� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER .' /l )",./
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2151 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DIANE & TONY BLADOS
Address 1 : 830 BAYVIEW AVENUE
City St Zip MATTITUCK NY 11952
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 # R10-99-0173
Name Of Owner BLADOS, TONY & DIANE
Mailing Address 1 830 BAYVIEW AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 225 PINE STREET
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 1 lot 36.003
Cross Street HORTON AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/01/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
/1,0 FOL4V
ELIZABETH LLE _ �I h'Z' yam►; Town Hall,53095 Main Road
TOWN CF:RK P.O. Box 1179
H 2 Southold, New York 11971
REGISTRAR OF VIT v► �1
MARRIAGE OFFICER Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER �� �JO ?��I1�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER =�' * a"�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 14, 1999
Transmitted herewith is a copy of application No. 2237 for a Cesspool/
Septic Tank Construction Permit submitted by:
Diane and Tony Blados
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:
ignatur
) - H
Dated
1
;, OFFICE OF THE TOWN CLERK 11' our,-
TOWN OF SOUTHOLD �' _ ` O�'I4neApplication No. _,R 7
FI I7ABETH A.NEVII.1F,TOWN CLERK O ►
P.O.BOX 1179 ;L Construction i----
SOUTHOLD,NEW YORK 11971
Alteration
Telephone �y,y Q�,' $10.00 -Residential Lam"
(516) 765-1801 '��.� "'"
�' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE k S
APPLICANT NAME: \O,.Y-ve_ q
• g 3 0 AA-PL-
./a%
APPLICANT ADDRESS: db • �' . lazew_ — - -
SEPTIC CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION O�RR ALTERATION
/�C.� -dot, i
s-e Sir Li / (=tea v A 3
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: l o,,, 1 e ,tet ricdoS
OWNER MAILING ADDRESS: % Q)(7„..0)
OWNER PROPERTY ADDRESS: dI 957.'A L
c i4-
TELEPHONE NUMBER OF CONTACT PERSON: 02 q 8 - /35- 5
TAX MAP NO. : Sectionl / '-f I Block (j I Lot 3 t . J
CROSS STREET : `./44.„t C-v`-
BUILDING PERMIT NUMBER CROSS REFERENCE:
- - Signature of Applicant
RECEIVED BY: / 1
Town Clerk's Office
DATE: 9/ v/9,0
/� -
.1 r ',y i l;:.••
•Y A -• • pow SCDHS. Ref. #R/D-99-0173
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The locations of wells and cesspools ve° 9 �'0 V4
shown hereon ore from field observations a \a �1. G. F'
and or Trym data obtained from olhers. o�� ���. —��) °e'
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poo SCALE: Y' s 90'
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TO AN ASSUMED DATL.IL •^ D, MY. 1197/
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"�t .,,o. 99'—293