HomeMy WebLinkAboutSimicich ��,IL�41f:01011110>sy�,'
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\\,,........_�_ "a` Town Hall, 53095 Main Road
e�� �i�' P.O. Box 1179
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JUDITH T.TERRY FAX
FAX(516)765-1823
TOWN CLERK
"����� TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 453 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SIMICICH, JOHN
Address 1 : 4250 BERGEN AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH
SERVICES ON 12/30/88 AND SO INDICATED ON SUBMITTED COPY OF SURVEY.
Name Of Owner SIMICICH, JOHN
Mailing Address 1 4250 BERGEN AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 4125 SOUND AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 1 lot 1 .000
Cross Street BERGEN AVENUE
Building Permit Number Cross Reference:
Issue Date: 1/10/89 Judith T. Terry
Southold Town Clerk
(TOWN SFAI 1
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P.O. Box 1179
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JUDITH T.TERRY ������i'//i/� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: January 5, 1988
Transmitted herewith is a copy of application No. 461 for a Cesspool/
Septic Tank Construction Permit submitted by:
John Simicich
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.
46/""i_e&z.....)
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
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Comments: • _it _ —' ___ t i 11
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Signature
t
Dated
OFFICE OF THE TOWN CLERK Oc��FFO(,�i3O
Town of Southold 0�, . Y G
Application No.
Judith T. Terry, Town Clerk � g-wx M:�.f�<;s=, �C pp �‘
Town Hall, 53095 Main Road o `� --® '� Construction
P. O. Box 1179 (51
Southold, New York 11971 �` } = Alteration
Telephone '61 .q[ �� Residential 1/
(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 /////y
APPLICANT NAME: a.)074/ 4) j//� /C. /C f/
APPLICANT ADDRESS: 17L,:q S`a /eei"� ,e /i / '6
jG i�-7i -4- v c k /C, V // 9-r-�
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
I / I
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 9L% ��
OWNER MAILING ADDRESS: a As-c.-c-)
,V,V. /79 C.7
OWNER PROPERTY ADDRESS: �� /n?.S'
74..e-e--,Liel.a.z..,_-,c,e,c_e_..)
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TELEPHONE NUMBER OF CONTACT PERSON: 9c? -,�F6o 4/
TAX MAP NO. : Section
w7/ Block / Lot /,-, / .
CROSS STREET: 157,--- .."-e-x-4-x-e-A--('-----
BUILDING PERMIT NUMBER CROSS REFERENCE:_
-----f(-9-1
Signature of Applicant awlRECEIVED BY: ;` `6
- wn -r's Office
DATE: //y., .,
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SCI!S Al'? 01�Lr ().11:5:754,47..11.5,i'.
icicc
$ 61 r)
. rc7)0 t4,
.......7-,,...,..... ./TA,W___.....---
now or formerly
Thorton E Smith
PLEASE NOTE
W Requires septic tank ,
c cover to grade.
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REVISIONS YOUNG & YOUNG
N 76°4914011W. AUG. 301988 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
24.721 DEC. 16, 1988
Dec 1E0988 ALDEN W. YOUNG HOWARD W.VOUNC
PROFESSIONAL ENGINEER AND LAND SURVEYOR
LAND SURVEYOR. N Y S LIC NO, 12845 N.Y.B. LIC. NO. 45083
SURVEY FOR: . _
UNAUTHORIZED ALTERATION OR ADDITION TO JOHN SI M I C I CH , Jr
'HIS IS SURV SURVE" IS A VIOLATION OF SECTION
T2W9 OF THE NEW YORK STATE EDUCATION S,�P'/E OF NE
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•'OPIES OF THIS SURVEY MAP NOT BEARING 4' b `O*�
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EMBOSSED SEAL SHALL NOT BE CONSIDERED .>tl. r " l'''
TO BE A VALID TRUE COPY AT G AR NTE: : '_;••
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TH DEPARTMENT-DATA FORAPPROVAL TO CONSTRUCT TE�j7 HOLE 2
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ARESr..WATER *AIN—ML± _*SOURCE OF WATER: PRIII�TE_PUBLIC_ -
rF CO.TAX MAP DIST 1000 SECTION 121 BLOCK JLOT P/A I T 5
OP 0I1. O.O _ ;,
=RE ARE NO OWELtINBS WITHIN 100 FEET OF THIS PROPERTY ` . $ LOAM2.0' .'
'R THAN THOSE SHOWN HEREON.
EWATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE _ ,',,` E
CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT $-
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