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ELIZABETH A.NEVILLE • 11 d 1 Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
1 c a
v, riv Southold, New York 11971
. ®
REGISTRAR OF VITAL STATISTICS �` 1% Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER `�y*®� ®0. Telephone (631) 765-1800
4111 4)
FREEDOM OF INFORMATION OFFICER posi
OFFICE OF THE TOWN CLERK
SOUTHOLD rlat509SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2640 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RANDAZZO BUILDING COMPANY
Address 1 : PO BOX 677
City St Zip AQUEBOGUE NY 11931
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 #R10-01-0118
Name Of Owner FUCHS, MANFRED & KATHERINE
Mailing Address 1 PO BOX 677
City St Zip AQUEBOGUE NY 11931
Property Address 1 WILLOW DRIVE-
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 5 lot 15.000
Cross Street CEDAR DRIVE
Building Permit Number Cross Reference:
Issue Date: 8/13/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERK ; ; P.O. Box 1179
t
REGISTRAR,OF VITAL STATISTICS � ® ,vv Southold, New York 11971
MARRIAGE OFFICER :. # Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER = 4®� ,ss22, ����. Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `zs'�����D”
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 9, 2001
Transmitted herewith is a copy of application No. 2728 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Randazzo Bldg Co inc for Manfred and Katherine Fuchs
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
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
7SignaZ
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Dated
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OFFICE OF THE TOWN CLERK .0. ��C�ULe
TOWN OF SOUTHOLD CSG Application No. ,)7�L
ELIZABETH A.NEVILLE,TOWN CLERK , o ':- 12 Construction K
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 %% p • •T : Alteration
Telephone `y0,�"�� ��O�i:, $10.00 -Residential
(631) 765-1800 . l ,,0 $25.00 Non-Residential
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TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee •$
DATE C--i7S-(t9 f
n
APPLICANT NAME: 21-1,(64--__'2,-7,c7 '3 �`c--.---, �-^-(4 `L
APPLICANT ADDRESS: 1 • 0 Uyx 6-77 A-0 ' cE' C3-diL ( 14 _
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
W1 Sg/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
OWNER OF PROPERTY: kKFR*-b -+Qtl'ag ( J FL)ct+s
OWNER MAILING ADDRESS: P. 0 FAA Cry? tek_de- JoC1?e- (( '3 ) ei•t
e
OWNER PROPERTY ADDRESS: ,LIT ( c LULL-CV LI 4fe.c(ite___ E', 144,4Rfopu
TELEPHONE NUMBER OF CONTACT PERSON: V 1720 —.2-'7 `7-2-2-47 115
TAX MAP NO. : Section I QDc7 Block 21— Lot O'S- — t c/ •
CROSS STREET: C9 4-2 1)2, d
BUILDING PERMIT NUMBER CROSS REFERENCE: .
/4A--
Signature of Applicant .
RECEIVED BY: 4, '
To Clerk's Office
DATE: <E1 (� (
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.. • ' ,Ii.SUFFOLK-COUNTY DEPARTMENT OF HEALTH SERVICES & // � ' `�
PERMIT-FOR•APPROVAI OF CONSTRUCTION FOR A. /
'' SINGLE FAMILY RESIDENCE ONLY e
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DATA 40fi.S' REF O. AP/4. 'CJ's d/�� o / � .
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. - FOR MAXIMUM OF, - .9 BEDROOMS ' - $�, ' - //
EXPIRE$THREE YEARS. DATE APPROVAL. * /
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