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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK try P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .�` Southold, New York 11971
e1 41' Fax 516 765-1823
MARRIAGE OFFICER ® • ( )
V® �q�®.0 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. 924 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RALPH AND CAROLYN SINOPOLI
Address 1 : P. O. BOX 620
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 9/29/92.
Name Of Owner SINOPOLI, RALPH AND CAROLYN
Mailing Address 1 P. O. BOX 620
City St Zip SOUTHOLD NY 11971
Property Address 1 PARK AVENUE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 56.00 block 1 lot 2.002
Cross Street POND AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/20/92 Judith T. Terry
Southold Town Clerk
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(TOWN SEAL)
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JUDITH T. TERRY ` ., Town Hall, 53095 Main Road
TOWN CLERK 11 P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �� � ���` Fax (516) 765-1823
MARRIAGE OFFICER ® .�A
_��� ��® �! Tel (516) 765-1801
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OFFICE OF THE TOWN CLERK irk- 77 -7 ;4 ==;°`�
TOWN OF SOUTHOLDi.)
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I \ 11 CT 1 61992 1
TO: Southold Town Building Department ithq� _ _ ,';5 ,�. .
FROM: Linda J. Cooper, Southold Town Clerk's Office4 TOWN `a G.OuTHOLD
DATED: October 15, 1992
Transmitted herewith is a copy of application No. 949 for a Cesspool/
Septic Tank Construction Permit submitted by:
Ralph and Carolyn Sinopoli -- --
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. •
Xyvy_d-Ac
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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Signature
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Dated
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OFFICE OF THE TOWN CLERK Oc.IFOLA- •
Town of Southold Qom'
Judith T. Terry, Town Clerk tr � Application Nof:77
9
Town Hall, 53095 Main Road
P. O. Box 1 179 u' t ' Construction V
�t
Southold, New York 11971 Alteration
Telephone 1 441,0 Residential V
(516) 765-1II01 " Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
RECEIVED
_APPLICATION
for
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392,
So,th0 P Tory
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CONSTRUCTION or ALTERATION PERMIT Clerk •
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE ) (p ICiCj
APPLICANT NAME: gi 1 On I 00 1 700 a
APPLICANT ADDRESS(( Bx Lo' -ct
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SEPTIC CESSPOOL J
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
1 — a S+Drd S 1 1-e., m L (x di i n
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: \�� i C xc* - 11\)0f)011
/ I\)Opn I j
OWNER MAILING ADDRESS: ()85y, aL
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OWNER PROPERTY ADDRESS: d_1 4111i a
L.
TELEPHONE NUMBER OF CONTACT, PERSON: 116S-0393
TAX MAP NO. : Section jam' LO Block / Lot a 2
CROSS STREET: iNC1 ; e+�
BUILDING PERMIT NUMBER CROSS REFEREN . E:.
7r ure of Applicant
RECEIVED BY .: •---6;7 Tgin lerl s Office
DATE: /C3 — I6- �
Q ` - - SUFFOLK CO.HEALTH DEPT.APPROVAL
H.S. NO. ' - • 1
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Z> NIAP OF: �?P,E2TY1- _ - • ,
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VACANT) V ttl -r ;
\ 2' \L CARO LY 5.1.1\1C). POJ ( - STATEMENT OF INTENT
l to I '—u, ' AT- THE WATER SUPPLY AND SEWAGE DISPOSAL,
di 2 i 4 SYSTEMS FOR THIS RESIDENCE WILL •
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161
oar u `T4, UFFiQL.D- `, CONFORM TO THE STANDARDS OF THE
-TCo5_ E._____---------1,•pI J . TOWN OF SOUTH•OLDti N.Y , . SUFFOLKS)
CO. DEPT. OF HEALTH SERVICES.
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• T APPLICANT
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3 I m-'' • SUFFOLK COUNTY DEPT. OF HEALTH
CA i
W SERVICES — FOR APPROVAL OF
r i :- 'IZ imi CONSTRUCTION ONLY SEP 2 1992
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