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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK p "ac P.O. Box 1179
trs Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �. �� Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ' .' 1 �O l$
4 � Telephone (516) 765-1801
11
FREEDOM OF INFORMATION OFFICER �l
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1220 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : FERUCIO FRANKOLA
Address 1 : 1900 GLEN ROAD
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
REPLACE EXISTING CESSPOOLS WITH TWO NEW POOLS
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION
INSPECTION REQUIRED.
Name Of Owner FRANKOLA, FERUCIO
Mailing Address 1 1900 GELN ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 1900 GLEN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 2 lot 36.000
Cross Street MAIN BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 10/13/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/ C2— CD• 6
ol :o
'JUDITH T. TERRY �L
Town Hall, 53095 Main Road
TOWN CLERK : p "ac
P.O.P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = .0 se Fax (516) 765-1823
MARRIAGE OFFICER ' .9 .aO se� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '_ / 4 �'
FREEDOM OF INFORMATION OFFICER =� �ii�� I
OFFICE OF THE TOWN CLERK 2f
TOWN OF SOUTHOLD l' F
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: September 29, 19941-0`,a�f`f�JF
t3 0
Transmitted herewith is a copy of application No. A1264 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Ferucio Frankola
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells, buildings,
property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Ade
4,1011
Signat e
Date
OFFIGE OF THE TOWN CLERK """'''-
• 'Town of Southold
Judith T. Terry, Town Clerk Application No.�'0� � =
Town Hall, 53095 Main Road ; = Construction
P. O. Box 1179 ` � M ` Alteration
Southold, New York 11971 ;tt'i
Telephone =D,jy01 ��� � $10.00 - Residential
(5 6) 765 801 - Jr ,, �' $25.00 Non Residential
I,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ q f�( � •
DATE 9/27/ 7
APPLICANT NAME: Get)czo e 4xJ
APPLICANT ADDRESS: 900 Crep
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
RC ®e—,c2 C/02-)CT ,go,c•si/a() 5 Com$ g o
/ 7-h1 ,041-‘' celt/4 3C 72' 'TJX
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: /TDO '
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7� -D S .--
TAX MAP NO. : Section ?s' Block 2. Lot _3�
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
1 u /
Signature of Applicant
RECEIVED BY: LU/«/-
/� wn� Clerk's Office
DATE: t/
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