HomeMy WebLinkAboutCopertino � i"
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ELIZABETH A.NEVILLE ��_' * Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER : .* ���, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �__ ®1 4;00Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER � southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2756 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN COPERTINO
Address 1 : PO BOX 336
City St Zip EAST MARION NY 11939
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 #R10-001-0207
Name Of Owner COPERTINO, JOHN
Mailing Address 1 PO BOX 336
City St Zip EAST MARION NY 11939
Property Address 1 725 WILLOW DRIVE
City St Zip EAST MARION NY 11939
Tax Map No. section 22.00 block 5 lot 13.000
Cross Street CEDAR DRIVE
Building Permit Number Cross Reference:
Issue Date: 3/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
111�® ®� (((JJJ""" lll...///
' ELIZABETH A. NEVILLE �1 �'� Town Hall, 53095 Main Road
TOWN CLERK % Z ; P.O. Box 1179
t a*REGISTRAR OF VITAL STATISTICS % Southold, New York 11971
MARRIAGE OFFICER ® �, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER `�-_ ®I i�®�11�' Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER �.����,,.�'1 southoldtown.northfork.net
OFFICE OF THE TOWN CLERK i `I';`''' .`', r1
fel, .�,�
TOWN OF SOUTHOLD ;'//!, ,r -' �i?
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17
TO: Southold Town Building Department � :' �' ®0� 't.i ;
FROM: Linda J. Cooper, Southold Town Clerk's Office ``'?,,,
DATED: February 27, 2002 .:-...=-4/ ,
= iy
Transmitted herewith is a copy of application No. - - for a Cesspool/Septic Tank Construction
Permit submitted by:
John Copertino
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: :ee ‘ />
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Signature
Dal— az
Dated
... OFFICE OF THE TOWN CLERK 'l�������••�•••�����• oL 8-6-7
TOWF ,I7ABETIiNOFSO E.,TOLDWN ',�•�oS�FFOtKc�G Application No.
P.O.BOX 1179 �� ra�
Construction
SOUTHOLD,NEW YORK 11971 Z
v
cn Alteration
Telephone : * �0�,�, $10.00 -Residential
(631) 765-1800 �l ,���
„„,,,, $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 R
APPLICANT NAME: _ Q A-1 CO P- ki
APPLICANT ADDRESS: P.. 0 ' t; k .> 3 — I4 44041 11
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
i(i-e w 0-0 PI -P
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 3-0/1 /U C Pe 0
OWNER MAILING ADDRESS: p 0 13 o--- 3 3 6
* 1O )O ) /t. 3
7
OWNER PROPERTY ADDRESS: o2 5 t(j/ L
TELEPHONE NUMBER OF CONTACT PERSON: V Ea $ 3 ' 7 `T
TAX MAP NO. : Section 0 a__ Block .,f Lot l
CROSS STREET: ce -o A- & bift. ( l0
BUILDING PERMIT NUMBER CROSS REFERENCE:
•. ature o •licant
RECEIVED BY:
Town Clerk's Office
DATE: '� /v(
•
AIRY ALTERATION OR ADDITION TO THIS SURVEY IS A VIDU
OF SECTION 72759 OF THE NEI,/ YQR7 j4TE EDUCATION LA‘
- S I OF l CXC F'T AS PER SECTION O9-,�fiB47 4 SIPN<'c ALL GERM.LVEY ROPERTY HEREON ARE VALID FUR THIS 1IAP AND COPIES THEREOF ON
SAID MAP rip COPIES DEAR THE IMPRESSED SEAL OF THE SI
- , , , •7 PS T MARION WHOSE SIGNATURE APPEARS HEREON; ,
°�N OF lr.±sOUTH OLD
�~•~ . +i7'i Y-'i�� COUNT NEW YORK • --
1000-22-05-13
SCALE: 3' =(w{(V l
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.,; ' (DWELLING)
- ��- 0Q LOT 47 C.P. 150'+
1-IGHPi 'NT AT EAST MARION, SECTION TWO, INC,
. FILE NO, 7755 JULY 13, 1984 o WELL
(VACANT>
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
PERMIT FOR APPROVAL,OF CONSTRUCTION FORA
SINGLE FAMILY RESIDENCE ONLY
LOTNUMBERS REFER TO HFICHPOINT AT EAST MARION, SECT ION
-' � p b a 07
ONEa FILED IN THE SURFL.7LK COUNTY CLERK'S OFf ICE ON ,JAN. DATE�( 0 H.5• 7"5----R D` •-V 1
11, 1984 AS FILE NO. 7680. APPROVED
--,'KII. , FOR MAXIMUM OF, 'F BEDROOMS - -
' 'r;I. „ani •,fai i[iar :with the STANDARDS FOR APPROVAL EXPIRES THREE YEARS FROM DATE OFAPPROVAL 1
;.•AND COINSTRUCTION OF SUBSURFACE SEWAGE __ _
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES ---4-ta-..tllE i-
'and will abide by the conditions set forth therein and 't t, y0 x'-'
on the permit to construct, . lo�N rjeF ��
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The location of wells and cesspools shown hereon are a,��,de , T
�/�f�lit4.ii s WKS. LIC. NO. 49618
:,from Field observations and or data obtained from others. r� F; -
ECI S” 6YDRS, P.C.
Elevat a- ,are referenced to an assumed datum. ����" a - � X20 •FAX.(631) 765-1
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