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ELIZABETH A.NEVILLE $�`1` �tk 1 Town Hall, 53095 Main Road
TOWN CLERK y 1 P.O. Box 1179
x Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER =*/* �O)',�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER : 1 * ',."
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2107 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOSEPH FISCHETTI
Address 1 : 1725 HOBART ROAD
City St Zip SOUTHOLD NY 11971
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 #R10-99-0112
Name Of Owner ZOITAS, JOHN
Mailing Address 1 193-03 45TH AVENUE
City St Zip FLUSHING NY 11358
Property Address 1 51405 THE LONG WAY
City St Zip EAST MARION NY 11939
Tax Map No. section 2.10 block 5 lot 14.000
Cross Street THE STRAND
Building Permit Number Cross Reference:
Issue Date: 7/06/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE •�`�` y�`�� Town Hall, 53095 Main Road
TOWN CLERK ; ti '� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS vSouthold, New York 11971
.
MARRIAGE OFFICER : 1 Fax (516) 765-6145
RECORDS MANAGEMENT OFFICER = �fO �0�,'�� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER - 1 Ai ".
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 25, 1999
Transmitted herewith is a copy of application No. 2195 for a Cesspool/
Septic Tank Construction Permit submitted by:
Joseph Fischetti for John Zoitas
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:
ignature
cI 74- Ic1 ' 9
Dated
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.
OFFICE OF THE TOWN CLERK ; �l !1',''COO[KQQ
TOWN OF SOUTHOLD , Application No. Z(1.5
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX u79 , Z . . ; Construction ✓
SOUTHOLD,NEW YORK 11971 O T
Alteration
Telephone OAro: $10.00 -Residential
(516) 765-1801 '-70l 44' 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 $ las
DATE 9
APPLICANT NAME: "O5eph F SCJ- ft;
APPLICANT ADDRESS: 17Q5 440 blc,d-
/ Soo+ike/cf •
SEPTIC 1� CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: X10 h n 2O i +19-s
OWNER MAILING ADDRESS: 93-(33 L/5TW dile
FIus‘,► r,5 uY 11358"
OWNER PROPERTY ADDRESS: 5405 e Larn Wa>/
TELEPHONE NUMBER OF CONTACT PERSON: TOseph FiSCketh
TAX MAP NO. : Section c:21 Block 5 Lot ) I
CROSS STREET: \'le S+rwhc{
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature f Applica
RECEIVED BY:
Town Clerk's Office
DATE: ('a5) 91
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COASTAL EROSION HAZARD AREA MAP
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ANY AL!ERA TION OR ADDITION TO THIS SURVEY IS A VIOLATION y}g •. IGS •.'VEYORS, P.C.
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. * ' ..7" 9651- 5020
EXCEPT AS PER SECTION 7209-SUBDIVISION 2 ALL CERTIFICATIONS fq,VX 909
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR E'+ '1'; ER STREET 99- 141
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IINOSE SIGNATURE APPEARS HEREON. cG, 4'49044014 .1 N.Y. 11971
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