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ELIZABETH A. NEVILLEyam►; Town Hall, 53095 Main Road
TOWN CLERK • c• 4.4P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v. •
Southold, New York 11971
MARRIAGE OFFICER O Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER V*Da /1�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER -"u1...
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2070 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : VINCENT LAROCCA
Address 1 : 22 CORIE COURT
City St Zip PORT JEFFERSON NY 11777
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 #R10-97-0103
Name Of Owner LA ROCCA, VINCENT
Mailing Address 1 22 CORIE COURT
City St Zip PORT JEFFERSON NY 11777
Property Address 1 185 WEST CREEK AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 13 lot 22.001
Cross Street OLD PASTURE ROAD
Building Permit Number Cross Reference:
Issue Date: 5/25/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
1111L-
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ELIZABETH A.NEVILLE `Z� r/y Town Hall, 53095 Main Road
TOWN CLERK % <r P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS rftFax (516) 765-1823
MARRIAGE OFFICER Z y �� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER �lJ
FREEDOM OF INFORMATION OFFICER ����
•tee. i�.�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 10, 1999
Transmitted herewith is a copy of application No. 2156 for a Cesspool/
Septic Tank Construction Permit submitted by:
Vincent LaRocca
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:
ignat
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Dated
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0}'F|tL OF [|(E I OWN CLERK
l'.wn ,,/ 5ooU .N
]\x|i!>` T . Tonry, Town Clerk
Application Nn�^ ,^� '���
[,`~" Hall, 63095 Main Road Construction
P. 0. Box 1179 A ' -�------
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Southold, New York 11971 Alteration ---
Telephone 4.4 f • Residential
(516) 765- 1801 `->?:j/'/ ','
Nun Residential
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TOWN OF S0UU|0LD
SOUT||OLD WASTEWATER DISPOSAL D|STR|CT
APPLICATION
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CONSTRUCT ION or ALTERATION PERMIT
SEPT IC TANK w CESSPOOL
Permit No.cy -/(90 70
/� -7��
Fee $
D/\ IE. �
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APPLICANT NAME: //ix/ ----~
APPLICANT ADDRESS:
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SEP T|C CESSPOOL
-_-'-- __-_-
|)[3CR|PTION OF 13R0`0SED CONSTRUCT ION OR ALTERATION
'---'------ ---' -
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LOCA ION MAP: Must he attached hereto |/ehore permit may he issued.
LOCATION OF PROPOSED CONS I RUCT ION OR ALTERATION :
OWNER OF PRUPERTY : �
OWNER MA!LING AN)HE3S�
--------'----------' ----- -'-'------ ---' --- --
OWNER PROPERTY n | ADDRESS :
/1-e/s,-'-- _ -
_
TE|EP||ONE NUMBER 0F CONTACT PER SON : 320 4�
��-c_�_�_ ___
TAX MAP NO. : SecUon Block /3 Lot 2:2, /__.__
7 '
CROSS Sl <EET :
BUILDING PERMIT NUMBER CROSS REFERENCE :
Signature
---�-- Applicant
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|<E[EIVED UY : / `'
----'town
Clerk's Office
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DATE: l
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Tex 130..n9 �9. •
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Si 1 am /om/Nor with the STANDARDS FOR APPROVAL •
AND CONSTRUCTION OF SUBSURFACE SEWAGE •
io"am oc l 21 P --'--
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? DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
1 d Boa^y Q�/ a °'x and will abide by the conditions set forth therein and on the
3 I s"""SM ,` `' V.1 \ permit to construct.
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- , i • SURVEY FOR
s P Q P �, °266 &� sa.�_ s / JOHN A. CLARKE
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�, 4 SUFFOLK COUNTY, NY.
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i } p \ The locations of wells and cesspools
shown hereon are from field observations
Q2h and or from data obtained from others.
ELEVA71CN$ARE REFERENCED
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0 TO AN ASSUMED DATUM- a I I&
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ANY ALTERA7TON OR ADDITION TO 7H�CS SLRVEY IS A VIOLATION gg
4, Y.S. c"NQ 494, ,/ 1 r OF SECTION 7209 OF THE IrEW YORK STATE EDUCATION LAM i
I . l►;isL, . Ui zs W. `, EXCEPT AS PER SECTION 7209-SUBDAISSCN z ALL CERT�cASmNS
'COM!'='" ORS, P.C. 4;c1.. £ el AN 4•Z8.,o� �gf I HEREON ARE VALD FOR THIS MAP AN7 COPIES TIEREOF DILY F
(516) 765 ' 5020 �% I . so, .'s ni 5 7 IA SAD MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
.o a -O a . 3, \ WHOSE SIGMA MIRE APPEARS HEREON
P. O. 'BOX 909 -2 / �•
1230 FRAMER STREET c� 1 ?E SIQ&F Q%}CFE `". ADDITIONALLY TO COMPLY 417TH SAD LAW THE �ALTERED BY'
1SOUTHOLD,
W.Y. 11971 2• OF ANOTHER scvMUST BE uSED BYsyoYRsMAAND p L> AS CTS COPY
o AREA = 12771 Acres 'BROUGHT-TO-DATE-ARE NOT IV COMPLIANCE WITH rHE CAW.
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