HomeMy WebLinkAboutPisacano (2) JUDITH T.TERRY a Town Hall, 53095 Main Road
TOWN CLERK ,g0 g P.O.Box 1179
,�� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �®� \� 1 Fax(516)765-1823
MARRIAGE OFFICER
N. �J��I'f
Telephone(516)765-1800
RECORDS MANAGEMENT OFFICER I ED I.�
FREEDOM OF INFORMATION OFFICER ,•0°
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1335 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MICHAEL PISACANO
Address 1 : P. O. BOX 40
City St Zip JAMESPORT NY 11947
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. #R10-95-0023.
Name Of Owner PISACANO, MICHAEL
Mailing Address 1 P. O. BOX 40
City St Zip JAMESPORT NY 11947
Property Address 1 BAYHAVEN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 4 lot 26.000
Cross Street BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 5/19/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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,, ,,ty, -JUDITH T. TERRY % ., . .4.. Town Hall, 53095 Main Road
TOWN CLERK , ® � :` P.O. Box 1179
� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax tt" Fax (516) 765-1823
MARRIAGE OFFICER ®II�' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER = ®1
FREEDOM OF INFORMATION OFFICER ���"rrrr1ri�ii
OFFICE OF THE TOWN CLERK —„
TOWN OF SOUTHOLO •'/Pi/r,�,_ �p
RAY S
TO: Southold Town Building Department ' ji-/ V
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FROM: Linda J. Cooper, Southold Town Clerk's Office ���_. _
DATED: May 11, 1995
Transmitted herewith is a copy of application No. 1384 for a Cesspool/
Septic Tank Construction Permit submitted by:
Michael Pisacano •
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 re--.commendations:
APPROVE v
DISAPPROVE
Comments: �-/,"Ji--jr7 4 ,%07- ,/_ /190.---A----.60 L3
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Signature O'
q/r/95
Dated
OFFICE OF THE TOWN CLERK �,.,,""" •
Town of Southold .�'' UFFOIk
Judith T. Terry, Town Clerk � e'�Gy�: Application No. / ki/
Town Hall, 53095'Main Road %���0
r7. Construction
P. 0. Box 1179 % v rn
Southold, New York 11971 �cn • yc,• Alteration
Telephone �Q��'� $10.00 - Residential ��~~
(516) 765-1801 = 1 � ' $25.00 - Non-Residential
TOWN OF SOUTHOLD ,
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
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for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ -
DATE
APPLICANT NAME:
APPLICANT ADDRESS: O_ t ? �� �,9-. i fetur-71-7/7 2
SEPTIC L/CESSPOOL L...----"
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: ' Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONST UCTION OR AL ERATION:
OWNER OF PROPERTY: �fyf-ta�yy
OWNER MAILING ADDRESS: /d Z Sfa 76. - e'
OWNER PROPERTY ADDRESS: Olaf _ 0-‘? A-1 0) 1.0 4- linAuck3
TELEPHONE NUMBER OF CONTACT PERSON: —
TAX MAP NO. : Section Block .8-f- Lot
CROSS STREET: Y
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
' Tow ClerW-s Office •
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DATE: 57/ `Z--- •
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SUFFO•
LK COUNTY CEPAR1MENr OR HEAMI SEFv�c s citivieD
FOR APPROVAL OF comuoridN OF
°#, FAMILY RESIDENCE ONLY
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