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ELIZABETH A. NEVILLE 010.1) Town Hall, 53095 Main Road
TOWN CLERK ; - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICER �i 0" 1°
Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER t le Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - 1 '
OFFICE OF THE TOWN CLERK
SOUTHOLD INASNENIASZER1111511319SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2685 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ANTHONY LAVIOLA
Address 1 : 21 PALERMO STREET
City St Zip HICKSVILLE NY 11801
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 # R10-01-0214
Name Of Owner LAVIOLA, ANTHONY & HEDY
Mailing Address 1 21 PALERMO STREET
City St Zip HICKSVILLE NY 11801
Property Address 1 FOUR WINDS COURT
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 6 lot 13.033
Cross Street AVENUE OF TREES
Building Permit Number Cross Reference:
Issue Date: 11/01/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ELIZABETH A.NEVILLE
Town Hall, 53095 Main Road
TOWN CLERK ® i P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �� 1,t Southold, New York 11971
MARRIAGE OFFICER : . rA 1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ® �i�l Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ' ,l"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 30, 2001
Transmitted herewith is a copy of application No. 2778 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Anthony and Hedy LaViola
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.
•
Signature
jeib/k7 ri
Dated
I �"
OFFICE OF THE TOWN CLERK ,'�' �l{O1
TOWN OF SOUTHOLD ,�''Q%5 CW ' Application No. (.775
ELIZABETH A.NEVILLE,TOWN CLERK A/
P.O.BOX 1179 Construction 1�
SOUTHOLD,NEW YORK 11971
v • lit11 Alteration
Telephone -V fir ' ' $10.00 -Residential
(631) 765-1800 Ol ��,�'0' $25.00 •-Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT ,
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE e/O/73 /‘17.
APPLICANT NAME: flri+Ilon \/ L- 0 Vioi
Ct
APPLICANT ADDRESS: a I (D /I ev" rn 0 Si re o f .
N1C' ksui11e-. /Jy . u gol
SEPTIC /CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION ORiALTERATION
- s +ory , Sin k� - 6wllaly kovHle_
s5
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION':
• OWNER OF PROPERTY: A WI- h o La V14 + / I e c l LaUicicu
l /
OWNER MAILING ADDRESS: a I Q I ex. I0 A )S-ii",
io
�IC CSp, „,__ ) ,.) 112 ° 1
OWNER PROPERTY ADDRESS: 1L o+ # 31 Four LLL ii ds Co u r±
fn3cel- Shores , SO0-f60 1d MY
TELEPHONE NUMBER OF CONTACT PERSON: 543 -73 59, ( 7
TAX MAP NO. : Section g O Block Lot 13 . 33
CROSS STREET: A U c o o e, 0+ i Tees
BUILDING PERMIT NUMBER CROSS REFERENCE: .
JL ./L�r / ' 64'1
” •
Signa re •f Applicant .
RECEIVED BY: A. r Z S ,
Town Clerk's Office
DATE: /0/3-0/(1
1
SURVEY OF LOT #31 �+i
"MAP OF NGL SHORES" ` N
LED 8-23—c15 S #a-r2a I.c , rYi I J,�f..; ,
SITUATE: BYVIEN ,
W
E
TON: SOUTHOL� cT _ F,t
U\ �,
► 11,.E
SUFFOLK COUNTY, NY ,,-.1?-:: ,,- ,-,,,,,,-. . . -;' 'T1
SURVEYED 4-20-2000, 1:r r I'
AMENDED I1-02-00,
11-06-00
SUFFOLK COUNTY TAX #
1000 - SS - 6 - 13.33
CERTIFIED TO:
Anthony LaViola
Hedy LaViola
Peconic Abstract Inc.
l0
® �,C jl
�°1
�, Vacant
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Z.
@\ ( OGO 'ti^
V J / i \ ,�
`\ test hole
t_] _ I eI=15 n 1
_ _ ' OF-1 • WAY *_ -10`\x'
00 FROPOSEo I _ _ —
(71
____
•OO, el=141O WAER SE— ICEEASM — —ENT '
_ — 81
- TEST HOLE
— I' 011W138.
'(:::?. \\ Sgl°5
topsail
1'
I
I ILOt*33
Tan
CO.'.I ala
pant
and
gravel
8 0
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FOR APPROVAL OF CONSTRUCTION FORA
`
SINGLE FAMILY RESIDENCE ONLY Sand
} Ground
DATE 1Olt 6��.� � . iaoo I - oai �j 120
wader
APPROVED AA / �i'
r sand
ForMaximal Or: : ma
PROPOSED
SEPTIC DETAIL DYVELLIN& EXPIRE.:., 4.;-..;REE Vrilliatii.FROM': 7174,FAP `AL
not to scale
Pr rodee I
EL= 13 5 exist! . grade max 2' 9r 13 5'
max.2' min.l'
min.!' Inv: cover Inv.= Il q 2
cover in,.= 112 9�9a1 III
leaching IIA1117 m y, pitch Milt I/4' pi
Pert •
pools- U4"Per ft
b'deep .
Ee do.
EL=5 ,iii*e, i-;...
min.3'
separation �A� �ki�Co -unautnorlteo alteration o addition to a survey
water EL=2 Q`_ 444.),1-- -
ground (.7"'•'
f �:7
y7' map bearing a license° land rSurveyor s seal l9 a
I t '1..„4 x, ik violation al section 7209 sub-div kion 2 of the
Z 1 New York State Education Law -
1
f*
fit`-tiv 'Only copies from the original of this survey
t - marked wftn a original of the land surveyor s
WATER MAIN SHOWN FROM SUFFOLK COUNTY ` 4�..f �,'
1'. stamped Baal snail be considered to be valid true
WATER AUTHORITY MAP 2I-P, SEPT. 8, IGg1 AI? " ' copies'
i y+'�� Q!� 'Certifications Indicated hereon signify that this
o+�; survey was prepared In accordance with the ex
ry ., !sting Code of Practice for Lane Surveys adopted
(� 0 '\t' �`� I by the New York State Association°f Professional
NOTES: g1':,�f�''+. 5V Av �'� Land Surveyors Said certifications shall run only
ik �t to the person for wnam the survey Is prepared
N c I'' and on his behalf to the title company.hereon
men-
, `O LAND ✓ /1�� tal agency and lending Institution listed hereon ane
A STAKE SET ` kdt- /!� to the assignees of the lending Institution Certifica-
tions are not transferable t°addlt lona] Institutions
J.114 N ', a EHLE x''.S LANS/ SJ tD V Y V.�
AREA = 31,q-13 SF OR 0.-13 ACRES
6 EAST MAIN STREET N.Y.S.LIC.NO. 50202
GRAPHIC, SCALE 1'1= 40' RIVERHEAD,N.Y. 11901
IM MI • 369-8288 Fax 369-8287 REF.HPSERRVER\D:\PROS\20-137