HomeMy WebLinkAboutCirincione, Lorin ,o"
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ELIZABETH A.NEVILLE 'y 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
RECORDS MANAGEMENT OFFICER �.y'flpl �a����,, Telephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER .����t��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2244 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LORIN CIRINCIONE
Address 1 : 18 SOUNDVIEW DRIVE
City St Zip SHOREHAM NY 11786
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 #R10-99-0081
Name Of Owner CIRINCIONE, LORIN
Mailing Address 1 18 SOUNDVIEW DRIVE
City St Zip SHOREHAM NY 11786
Property Address 1 4225 MILL LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 107.00 block 4 lot 2.006
Cross Street WICKHAM AVENUE
Building Permit Number Cross Reference:
Issue Date: 2/18/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE _ :; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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v n� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax (631) 765 6145
MARRIAGE OFFICER :O# `��1�,
RECORDS MANAGEMENT OFFICER L,�Q! igg -a0 0. Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ,�•0
-.
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 17, 2000
•
Transmitted herewith is a copy of application No. 2332 for a Cesspool/
Septic Tank Construction Permit submitted by:
Lorin V. Cirincione •
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 applic tion and location map of the project cited above
and make the following r ommendations:
APPROVE
DISAPPROVE
Comments:
r`
Si ature
Dated
bot
,o..,.n •
(n10E OF THE TOWN CLERK1' J
TOWN SOUTHOLD CLERK
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WN ' ; Application Not
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ELIZABETH A.NEVILLE, $ .�
P.O.BOX 1179 " "m R Construction
SOUTHOLD,NEW YORK 11971 - ,
Alteration f
Telephone ° $10.00 -Residential
(516) 765-1801 1 ,,o` $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 1)Ca oC�
APPLICANT NAME: Lo{'t
APPLICANT ADDRESS: 18 Souvtov 'ew I�—
Cvl�c�e /i �g
SEPTIC CESSPOOL K
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/Ue c cit / 40,14 a to i C -
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Lp-r-ty‘ V , if(v,C r U/re
OWNER MAILING ADDRESS: CoU,aOd i`(.4.s a
S kcxei,)o-w, N Le, //7)(C,
OWNER PROPERTY ADDRESS: `-/2 Z) /14)// £a4'1
/414-TTTTt1 /L •L(.
TELEPHONE NUMBER OF CONTACT PERSON: 0/Q9-i yo
TAX MAP NO. : Section /C77 - Block 1-/ Lot 2 . 6
CROSS STREET: jv f ck h et.k/
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatu a of plicant
RECEIVED BY:
Town Clerk's Office
DATE:
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