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OFFICE OF THE TOWN CLERK OFR/re
Town of Southold �G
Judith T. Terry, Town Clerk . r
• Town Hall 53095 Main Road
P. 0. Box 1179 •un g4'& g$
Southold, New York 11971 OOff-
Telephone '4.
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(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 129 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool x
PERMIT ISSUED TO:
NAME: Vito Randazzo (Randazzo Building Co , Inc
ADDRESS: 127 Swan Lake Drive
Patchogue, New York 11772
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New "single family dwelling
COMMENTS:) Approved to put septic system and well as indicated on
SCHD approved survey.
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Peter and Margaret Sienk
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS : Mill Lane
Peconic, New York
TAX MAP NO. : Section 74 Block 2 Lot p/o 10.1
CROSS STREET: County Road 48
BUILDING PERMIT NUMBER CROSS REFERENCE: Unknown
Judith T. Ter�
Southold Town Clerk
II
DATE : March 31 , 1987 1
(TOWN' SEAL)
I 011100,,��.I
' t S y \7.10_,._ .J AZ±.j _
'. f 4 al% Town Hall, 53095 Main Road
... ��,'�. "F: ;;-ty ,�44 P.O. Box 1179
_°'� a�is iJ Southold, New York 11971
JUDITH T TERRY
.01:0,•mo -1° TELEPHONE
TOWN CLI•.RI\ (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
March 31 , 1987 -
Vito Randazzo
Randazzo Building Co. , Inc.
127 Swan Lake Drive
Patchogue, NY 11772
Re: Peter and Margaret Sienk
Mill Lane -
Peconic, NY
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic'Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25.00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
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For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly ?tours,
7.
Judith T. Terry
Southold Town Clerk
Enclosures (3)
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OFFICE OF THE TOWN CLERK , _
Town of Southold
Judith T. Terry, Town Clerk Application No. �3/ _
Town Hall, 53095 Main Road Construction I/
P. 0. Box 1179 Alteration
Southold, New York 11971
Tele hone Residential
P
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL -
• Permit No.1%,.L\betc.G—•
Fee .$ / O -
DATE 3/ (V7
APPLICANT NAME: V Erb ' N -?i:•��
APPLICANT ADDRESS: 12.7 Slow Lice_
-y, i ) 77?
•
SEPTIC /CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
0 iktE SMS Awe Lc- — .
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION
(Z �}- ► Ula-6s- .-7\-- (a t
OWNER MAILING ADDRESS: qA. IPPC�/.0C--
OWNER
-OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: LPN- 63lg
TAX MAP NO. : Section Block ®r(4-( Lot 2 70 fJi./
CROSS STREET: Co(N t( /425 47I
BUILDING PERMIT NUMBER CROSS REFERENCE:
/
Signature o,rApplicant
RECEIVED BY:
Town jerk's Of ice
DATE: CL/} Sri •
4 `a•yr!\-ate: -.u1-.d4s.f2'_S'S .
'' "''',.,', SUFFOLK CO. HEALTH DEPT. APPROVAL
l;` ; ,^ .,, • H S NO.
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' �(\ \ STATEMENT OF INTENT
J -" "� \ VT .n- THE WATER SUPPLY AND SEWAGE DISPOSAL
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't<, e\'\ 2Q ' LaK`•! CONFORM TO THE STANDARDS OF THE
� `\ SUFFOLK O�DEPT OF EALTH�i VICES
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