HomeMy WebLinkAboutRoberteillo, Dr ��, O,
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ELIZABETH A.NEVILLE h(, 0�; Town Hall, 53095 Main Road
TOWN CLERK p -� P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Al
• O yC Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER '
MARRIAGE OFFICER ` Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER ' '� go
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2166 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ALBRECHT LAND CONT., INC
Address 1 : 5665 MAIN ROAD
City St Zip MATTTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner DR ROBERTEILLO
Mailing Address 1 275 SOUNDVIEW AVENUE EXT.
City St Zip SOUTHOLD NY 11971
Property Address 1 275 SOUNDVIEW AVENUE EXT.
City St Zip SOUTHOLD NY 11971
Tax Map No. section 50.00 block 2 lot 5.000
Cross Street HORTON'S LANE
Building Permit Number Cross Reference:
Issue Date: 10/05/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
00,4,400
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ELIZABETH A.NEVILLE $�Z` .4..84 %` Town Hall, 53095 Main Road
TOWN CLERK y
1-4
P.O. Box 1179
2 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V. n1 1
MARRIAGE OFFICER 1 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER `� 4fo A;1•••1 Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER -.4 '� ���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: October 4, 1999
Transmitted herewith is a copy of application No. 2256 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Albrecht Land Cont. Inc. for Dr. Roberteillo
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Signat
Date Pb" V f 9
t V
OFFICE OF THE TOWN CLERK ,1°.i ��IOLK
TOWN OF SOUTHOLD ����� CQG ;` Application No.02. 02 6
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 ; _ _ Construction
SOUTHOLD,NEW YORK 11971 ; a T 4/
Alteration
Telephone �O.j� .,/ $10.00 - Residential ✓'
(516) 765-1801 -- Olnir ag, 0,��'� $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: 4Ll Q-L 14 I (A)A , (40A91- IOC
APPLICANT ADDRESS: ,5--(a -- n-74 /N 2.
/,24 TrirL' A AY, Ng 5-2-- .
SEPTIC
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/ 466, Reg/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 21-/S• Sovo#0m 1vEEms, . tQ. P)vJ?Lr -21/10
OWNER MAILING ADDRESS: 364Y41 SC?ctil-foc-6 fly /( . 7(
OWNER PROPERTY ADDRESS: g41
TELEPHONE NUMBER OF CONTACT PERSON: 2.W' 6-30D (s-coi_t_.:)
TAX MAP NO. : Section .5-0 Block L Lot ..>.
CROSS STREET: F\0404S IhNC_
BUILDING PERMIT NUMBER CROSS REFEREN E:
f � / /' ..
Signat re of Applicant
RECEIVED BY: ,1
own CI rk's Mice
DATE: /p- it - fj
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