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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK ® rTi P.O. Box 1179
ch � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V® Fax (516) 765-1823
MARRIAGE OFFICER •r,' •® �� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER =_7®1 i.
FREEDOM OF INFORMATION OFFICER r���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1157 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DAVID AND LINDA KNOERNSCHILD
Address 1 : P. O. BOX 528
City St Zip WADING RIVER NY 11792
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF #R10-94-0047
Name Of Owner SAVARESE, ANTHONY AND ELAINE
Mailing Address 1 1801 SOUTH OCEAN DRIVE
APT. 934
City St Zip HALLANDALE FL 33009
Property Address 1 120 ROBINSON LANE
City St Zip PECON I C NY 11958
Tax Map No. section 98.00 block 4 lot 39.000
Cross Street INDIAN NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 7/07/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® t P.O. Box 1179
LP w Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �Y® �. ��� Fax (516) 765-1823
MARRIAGE OFFICER /A, a*® "t Telephone (516) 765 1801
RECORDS MANAGEMENT OFFICER 7®1 1� ��
FREEDOM OF INFORMATION OFFICER „��/i//�/to
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD �' n
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TO: Southold Town Building Department L1 I JUN 2
8 199
FROM: Linda J. Cooper, Southold Town Clerk's Office BLDG DEPI '
T
DATED: June 27, 1994 roWlyoFS101JTHOLD
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Transmitted herewith is a copy of application No. 1200 for a Cesspool/
Septic Tank Construction Permit submitted by:
Knoernschild for Savarese
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.
s
G G`teG
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE t--'---
DISAPPROVE
Comments: /•- �/ ?
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Signatu - /
9 9
Dated
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OFFICE OF THE TOWN CLERK ,,,'",,,,"'•,,
Town of Southold �'a Ov
Judith T. Terry, Town Clerk ��' ® � ' a - l/� Application No.
Town Hall, 53095 Main Road ; 4` '• '; .� ; Construction (/
P. O. Box 1179 : Alteration
Southold, New York 11971 ' •. �'
Telephone ,� �� � $10.00 - Residential
(516) 765-1801 = 1 NI% 'e $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 Jilt-e 1994
APPLICANT NAME: 1av►dT /Linda A . dChoer'�schilo�
APPLICANT ADDRESS: P.O . ? 6?( 5�2_S 1
/ l�di i r 1-� �
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!V� (l?1 r�
SEPTIC CESSPOOL v
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
s�i7k Fc- n c/, w-(K
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A Vlfil6ny Sauar'ese/eiCiine SaivareSe-
OWNER MAILING ADDRESS: 1601Sci.d-h oecan � Apt 931-
- -l-ctjio da(e, F,. E3609
OWNER PROPERTY ADDRESS: arid/an Pvee . VS ((2OUJnstLa
Pecan cei j
TELEPHONE NUMBER OF CONTACT PERSON: 5I ( -92_9 - 6273 7
TAX MAP NO. : Section R 8 Block 4- Lot 39
CROSS STREET: --nrt J-O r N eCk �OQQQL
BUILDING PERMIT NUMBER CROSS REFERENCE:
Za %
Signatur of Applicant
RECEIVED BY:
KElerk's Office
DATE: JUN 2 71994
[own Clerk 600014
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GuARAMTEED 0 cexreres4.141-4012TGAGE-Mie
AS suaveve 17 MAY 26,1994
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RODERICK VAN TUYL.P.0 ......,
LICENSED LAND SURVEYORS
GREENPORT NEW YORK
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S.C. DEPT. OF .
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A 1EMENIr,.OF T'
THE-WATER SUPPLY•�rND SEWAGE DISPOSAL
— SYSTEMS FOR ' THIS' RESIDENCE 'WILL
PECG NNNK- CONFORM TO THE STANDARDS OF THE
�•, . SUFFOLK CO. DEPT. OF HEALTH,SERVICES.
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APPLICANT
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SUFFOLK COUNTY `DEPT. OF 'HEALTH
SE,R V ICES -• FOR • ' APPROVAL FOR
k/ , CONSTRUCTION ONLY
DATE: .; .._6:-..2— -�--�
H. S. REF. NO.. D ` ' �7
APPROVED' !. 4,4 )..:,/: : 4.4 —i , ,
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