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ELIZABETH A.NEVILLE •® ; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
�• Southold, New York 11971
REGISTRAR OF VITAL STATISTICS W % Fax (631) 765-6145
MARRIAGE OFFICER ®�, �1
RECORDS MANAGEMENT OFFICER �_ ®� 1°1�•�
�i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2716 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PAMELA LIGUORI
Address 1 : 36 IRVING PLACE
City St Zip ISLIP TERRACE NY 11752
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 #R10-98-0037
Name Of Owner LIGOURI, PAMELA
Mailing Address 1 36 IRVING PLACE
City St Zip ISLIP TERRACE NY 11752
Property Address 1 155 BROADWATERS ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 12 lot 8.001
Cross Street VANSTON ROAD
Building Permit Number Cross Reference:
Issue Date: 1/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
(91/ 1 (to .
ELIZABETH A.NEVILLE I����o 0 Town Hall, 53095 Main Road
TOWN CLERK N y - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t A 4$ Southold, New York 11971
MARRIAGE OFFICER 4* s° Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �__ Qd ��®iii Fax
(631) 765-1800
FREEDOM OF INFORMATION OFFICER ---'.....0°.
.. ,� southoldtown.northfork.net
....-, ''
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department '''��-----_�.—_T- _
FROM: Linda J. Cooper, Southold Town Clerk's Office i1.,•<
f
DATED: December 28, 2001 1,_iJAN di 1n
et-OG D- r.
Transmitted herewith is a copy of application No. 2811 for a Cesspool/Septi f Az:iF ;=,t1T«pLD
CONSTRUCTION/ALTERATION Permit submitted by:
Pamela Liguori
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. .
7.7,,,.......".,,,,,,4,
Signature
/ �2 o
Dated
OFFICE OF THE TOWN CLERK 01.640111.1W--
TOWN OF SOUTHOLD
' jApplication No. a ��
ELIZABETH A.NEVII.i.R,TOWNNRK 4
P.O.BOX 1179 • Construction t/
SOUTHOLD,NEW YOU 11971 0 •
�T t
Alteration
•
Telephone ,y Q`C,�, ' $10.00 -Residential
p 1D
(63t) 765-1800 =- �1. ,�. $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE !(91as'/bi
APPLICANT NAME: 'P lu..e.ta Li'GVor/
APPLICANT ADDRESS: 3 C9 I -U r 06) P/A-C
i-JU
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Q;i n 9 IL aft'�� r'e ��� - /U et-0 ci_ _u-e (it o
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Ta V}1-e IG7 L C uo}'i
OWNER MAILING ADDRESS: 3C0 -,21 1 IQG<
SSL
e—rerraCC_l &LI //73
OWNER PROPERTY ADDRESS: / 6-5- -p roG,Otua 2 S / OOC
att 0OJ(J ., AA1
TELEPHONE NUMBER OF CONTACT PERSON: to 3)-5 ?1 T F-5 C) 0
TAX MAP NO. : Section UA/ OM Block J .OD Lot D ®F'd O /
CROSS STREET: YAUS%C7/)
BUILDING PERMIT NUMBER CROSS REFERENCE: .
Signature o Applicant
RECEIVED BY:
To n Cle 's Office
DATE:
.�.,, ,
ts. ,. ``'',- SUFFOLK CO. HEALTH DEPT.APPROVAL C
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5, u I' 12O1°tD -' `�•- STATEMENT OF INTENT
- ��. ••,..,, i �`�� THE WATER SUPPLY AND SEWAGE DISPOSAL
`.�; '~�. NOP.,,f v) kiA 5A+,•U r-'0i 4.-r,- SYSTEMS FOR THIS RESIDENCE WILL
—�1T ��I28 _ CONFORM TO THE STANDARDS OF THE
9,p ' ''S 112R=_.--------_ S 12.'5410"_G'_- Ila' .....,,..411 __ S.9°3
moo r s 77- Af ki J .C') 1i-40L L. • N' SUFFOLK CO. DEPT. OF HEALTH SERVICES,
3 1J __ 6 Zvi 5. • 8 4- \ (S)
t-? / f (T!„c3 $ - • APPLICANT
-------- \ `�- -i •ems .• U SUFFOLK COUNTY DEPT. OF HEALTH
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� S VS ) W SERVICES — FOR APPROVAL OF
NO' t I • •� , W o� �+ , ) SUFFOLK cow4 D. ThE TOFHEALTHSERVICES CONSTRUCTION ONLY
l� �` r PEP�t', vOa • PP1A OF CONSTRUCTION a'ION FORA DATE:
���`� "� SE'dvs,i>, Al' `�I. IDE�IOE ONLY H. S. REF. NO..
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t.Y � ODATE 54(° < k g4�' .NO J (0 -g4 ®37APPROVED:
�O�ZaI�`706:70.2.
� APPROVED ..ifi� SUFFOLK CO. TAX MAP DESIGNATION:
, p44, e��� _ � ��.� �to.1 FORMAXIMUM';OF ,Y BEDROOMS DIST. SECT. BLOCK PCL.
- �e� _ ...._ '__ _ - 1�t 104 -12 - Ft4 -
d0 _ ;c s 1t , i'�CtJSE ALS.. -40` I OWNERS ADDRESS: •
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tL} 1 A f r s c t� �'• v 'a7., V L I V�I�1 c,-,,,.�:ti_parson for v.hzr.1i'toa::e
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- 0 AVAILABLE P,,NJ MAY /AFFECT” .DCI �'i. _...F---- BROWN
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' . ~� ? `?� MAY 1 i 1998 -
I 01 SEAL'
P 35' M4- AMF_F lL.'EC F-E5_K�,199'=� r MEDIUM ;;,i 417->,�
�_y WELL L. AC'C�_ 5,:`�i9_D �_-- _.- _____ - TO �✓.,G•< V,.� 1 i
-ro``��� �'� -7:-_ - MAY 10995 COAR$E n ` ,:
s--4;� jG ty it N•65°2g 1,t %Ai' . __ .-__ t RSSURVE` EP A.PIZ, 17i SAND , A.tI: , '`i
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LICENSED LANG SURVEYORS R -.y
.� .450`1 GREENPORT NEW YORK -