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ELIZABETH A.NEVILLE ��` Town Hall, 53095 Main Road
TOWN CLERK % ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER4 , Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER ; , �� �i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER 2-s' ,s"
OFFICE OF THE TOWN CLERK
SOUTHOLD `WAVESNATIERTEILSIBOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2583 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : THOMAS MARZANO
Address 1 : 17 WEST MAIN STREET
City St Zip SMITHTOWN NY 11787
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-00-0221
Name Of Owner THOMAS MARZANO
Mailing Address 1 17 WEST MAIN STREET
City St Zip SMITHTOWN NY 11787
Property Address 1 870 CHAMPLIN PLACE
City St Zip GREENPORT NY 11944
Tax Map No. section 34.00 block 5 lot 19.000
Cross Street MANHANSET AVENUE
Building Permit Number Cross Reference:
Issue Date: 5/17/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
41
® % nn4AAY 5
ELIZABETH A. NEVILLE1114. ®�1 _\ jtlF n�Town Hall, 53095 Main Road
TOWN CLERK ; H _ - _ = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` ry=%L'" '`1-' .
� � -n�=,�a„�,., .,t- ,�1,-;�., , _ Southold, New York 11971
J.,
MARRIAGE OFFICER `� sfiL ��,11 �� �----<Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_7Q4
*a®,�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �9"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 14, 2001
Transmitted herewith is a copy of application No. 2671 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Thomas Marzano
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE r,
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings, property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
lure
�1 fec
Dated
OFFICE OF THE TOWN CLERK 1114 Wire
TOWN OF SOUTHOLD e DA-_, Application No. 4r?
ELIZABETH A.NEVE LF,TOWN CLERK O
P.O.BOX 1179
Construction
SOUTHOLD,NEW YORK 11971v •
ern
Alteration
Telephone �0-�`� $10.00 - Residential
(516) 765-1801 '1
,0 $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK ,or CESSPOOL
•
Permit No.
Fee .$
DATE s 17 0
APPLICANT NAME: gfi\ QfZ
APPLICANT ADDRESS: fl S4 •
5 rn Irl t d c,- . n c1 ) 1 73 7
SEPTIC V CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
C rrns ,mac c,_f 3 r3 fa $ F P.-
LOCATION
ZLOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 10 rwcts M C s z_74•),),0
OWNER MAILING ADDRESS: ( i VJ . M G s.. Si- .
' rn , 111'3 7
OWNER PROPERTY ADDRESS: C,Q, 4,„„ L , P,p
TELEPHONE NUMBER OF CONTACT PERSON: (p 31 - 103/
TAX MAP NO. : Section t 3Block 5 Lot 9
CROSS STREET: MazvattA,LOCr
BUILDING PERMIT NUMBER CROSS REFERENCE:
---/
a ' .
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
SURVEY OF PROPERTY i
SI TU,4TE: NEAR GREENPORT l'1:1---C=t'''//=l) N
TOWN: SOUTHOLD .:1t.:,-"tjL.1) ut.P....%, 1 • P1*
SUFFOLK COUNTY, NY 2CrJ3 9'5P [9 1),i 12: 99
F
SURVEYED 08-22-2000 • T OF iii_ ,LTIi SEM CES
SUFFOLK COUNTY TAX
OFFICE 1'iASIEWAI Ei2 fieri 1T `s
1000-34-5-19
CERTIFIED TO
L-10
THOMAS MARZANO
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES '''''
coc.e
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
SINGLE FAMILY RESIDENCE ONLY 1 1..
1 CROWS Yt4TFR 65•
r
DATE 10/400H.S.REF.No -00 .-OkaI ,
.oN
APPROVED
FOR MAXIMUM OF 12
• BEDROOMS T
EXPIRES THREE YEARS FROM DATE OF APPROVAL �f 1
l
K 10 —%-eLQO �0
NOTES. '''`0' Nci - �:� """'a2:a. ..,
Ot<� G Eye`•L•� �P....a.�d ..e le Le.11 Lne
• PIPE FOUND i l < ` °� s a""
9 --p
AREA = 13,803 SF OR 0 52 ACRES * * .,J ¢(� JOHN
EHLERS�g g /�y�7y�e "tea "
o� No��7���, 4).°Oe JOH N C. E W ,��� Ll�lald� SURVEYOR
�"'e.O LAND SJi°�,r 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 •
rGRAPH IC SCALE 1"= 20' ' '" ' RIVERHEAD,N.Y.11901
369-8288 Fax 369-8287 REF.VHp serverWROS\20-243.pro
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