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JUDITH T. TERRY ; ` Town Hall, 53095 Main Road
TOWN CLERK z T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER ® O� � Fax (516) 765-1823
�� �
_ i Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1052 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : STEPHEN J. PERRICONE
Address 1 : P. O.BOX 41
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES REF. 3`93-SO-67.
Name Of Owner PERRICONE, STEPHEN J.
Mailing Address 1 P. O. BOX 41
City St Zip MATTITUCK NY 11952
Property Address 1 ROBINSON ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 81 .00 block 1 lot 16.012
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 10/27/93 Judith T. Terry
Southold Town Clerk
(TOWN SFM
1 4
it-
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® T P.O. Box 1179
REGISTRAR OF VITAL STATISTICStrs
Southold, New York 11971
t Fax (516) 765-1823
MARRIAGE OFFICER ® ®r�r
`= man it lb to� Telephone (516) 765-1801
_ I
1,11\V OCT "'' �9�OFFICE OF THE TOWN CLERK
jto[ TOWN OF SOUTHOLD
LI al., D�:P_l, 'r
TOWN OF SGL; :01
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 7, 1993
Transmitted herewith is a copy of application No. 1083 for a Cesspool/
Septic Tank Construction Permit submitted by:
Stephen Perricone
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:
/z /'
APPROVE v
DISAPPROVE
Comments: 7&itttf -ern 9'3 -sem' - c 7
Si.natur-
Dated `
I
OFFICE OF THE TOWN CLERK �cgFULK
Town of y , ,61 Application No. (U St
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road ` Construction
P. O. Box 1179 cr3 ;t ;:r
Southold, New York 11971 ,y� Alteration
Telephone _0! iNd '1 i' Residential L
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $/'
DATE 9I 1.5-193
APPLICANT NAME: S%FpfE/-/ J , PERRIGOcL(t
APPLICANT ADDRESS: 7 (f 7 p S/ PQ X cf l
T4 k i—T 1.t"(1 G i-c )SEPTIC [ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/V77I4/ (9 Ni= FAM I— y 11) 14),,! 1v6_
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Tt/3 H j=am/ T. Q N I= -
OWNER MAILING ADDRESS: -7 (l Z 0 117- ql ' Aa 60 Lf 1
AT iTVC /1 l�/, � . ) 1 °)S-1_,
OWNER PROPERTY ADDRESS: # ( p &/i'-/S jI , a-1)
) o LtrH-pL) , y, / I 'i7 /
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section Block l Lot
CROSS STREET: ,Iza i2,q-/zi d_ilyir i 15.w (,Q O -
BUILDING PERMIT NUMBER CROSS REFERENCE:
(?-2-A-AA'°-"6"\'‘AH
Signat re of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: / 6/7
1
SUFFOLK CO HEALTH DEPT APPROVAL,' ! •
' H S NO. ,
I 'MAP CIS' P•R �PE2TY FAY se
! SI �2L!E`r L FO2. Edi T ES BARS tO 3 DATE A fi�AL
I1 ! i N/F PAr A01SE Ft71NT ASE-N. // C "1---7\/E ,�r- f' r)4 ��I t..
2 i .VACANT STATEMENT OF INTENT
_ THE WATER SUPPLY AND SEWAGE DISPOSAL
• In / PA1?AD` SE POINT • SYSTEMS FOR THIS RESIDENCE WILL
i _ I - CONFORM TO THE STANDARDS OF THE
Ctry � _o j TrJv./ OF SOU - , SUFFOLK CO DEPT OF HEALTH SERVICES.
4 ' 'T!-1''I D N.Y.
O "pc, ISI
0, I LI_ 0 I \\ APPLICANT
• f in \ \
f Q�� �=J f!,\ i \ SUFFOLK COUNTY DEPT OF HEALTH0; Q .. %� \ SERVICES — FOR APPROVAL FOR
�' r 'o (VACANT)
CONSTRUCTION ONLY
';` C \ ��' I DATE SEP 14 1993
S K•
2_ �. ! H.S REF: f 3) b 44
APPROVED
t JJ 507 EXPN- i"-- C;� \ C ``fit
- al ;i' O „c. -". I PROP' `S` \ X .I
SUFFOLK CO.TAX MAP DESIGNATION•
N ice; d' .../....1_ , X i SEPTIC SO '--.. I{ DIST. SECT BLOCK PCL. •
7 -- �� i ' -I \ 1000 81 1 16.12 '
�,' 1 `,s,, /' <90
�j OWNERS ADDRESS
j '• 1930 LEEWAQD 02.
,, \ 12 • 6, o / �` 1 _ALE 50"°t 50U71-10L0 N.Y. 119"II
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• _ AMENDED AUG 111993 w
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Pt:CE.....
ti 11 ` GUARANTEED TO Fif�ST P,ME17.4..1 CP.; ! Go °�`;
Col uouSE - - TITLE INSURANCE CO,:# E C /NE1Z a :* .---;'''''i• e
AUG3STANT - - L� - ' _ o,
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RODERICK VAN TUYL,P.C. O tiSFa tn.. Q
r; - ;%MRSEEMS LICENSED LAND SURVEYORS
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GREENPORT NEW YORK