HomeMy WebLinkAboutSarno OFFOU
C®G
LIZABETH A.NEVILLE ,���� '� Town Hall,53095 Main Road
..
TOWN CLERK % o P.O.Box 1179
RE ISTRAR OF VITAL STATISTICS w Southold,New York 11971
MARRIAGE OFFICER I� Fax(631) 765-6145
REI ORDS MANAGEMENT OFFICER `�y'*O j �a®�,o'' Telephone (631) 765-1800
FREE DOM 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. 3093 R Residential x Non-Residential
F.e $ 10.00 Septic X Cesspool
P`.RMIT ISSUED TO:
N.me : PECONNIC CESSPOOL
Andress 1: PO BOX 972
C'ty St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
A'PROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS,
B ILDINGS, PROPERTY LINES AND WATER BODIES.
E CAVATION INSPECTINO REQUIRED.
Nkme of Owner SARNO, JOHN
M.;iling Address 1 519 DALLAM COURT
C ty St Zip BEL AIR MD 21014
P operty Address 1 1350' SIGSBEE ROAD
C.ty St Zip MATTITUCK NY 11952
T.x Map No. section 144.00 block 1 lot 6.002
C oss Street '
B ilding Permit Number Cross Reference:
I- sue Date: 10/20/03 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
l '44
ELIZABETH A.NEVILLE ,'h`Z` Gy Town Hall, 53095 Main Road
TOWN CLERK ® , P.O.Box 1179
en Z Southold New York 11971
REGISTRAR OF VITAL STATISTICS ; $ Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER =491 * '0s'0isoutholdtown.northfork.net
(or i` 1 L
,;' OFFICE OF THE TOWN CLERK
ttJ 16 2003 TOWN OF SOUTHOLD
I.6P�r.---1�=- -':✓'�Southo1d Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 16, 2003
Transmitted herewith is a copy of application No. 3227 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Peconic Cesspool for John Sarno
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
3
Dated
OFFICE OF THE TOWN CLERK ,'t'° ' UL,k'^•
TOWN OF SOUTHOLD ,', (�% `OGy Application No.3aa.)
ELIZABETH A.NEVILLE,TOWN CLERK
' P.O.BOX 1179 : ;4; Construction L/
SOUTHOLD,NEW YORK 11971 p ze Alteration
Telephone �Q��'1, $10.00 - Residential ?i
(631) 765-1800 �,, $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE ?AA 3
APPLICANT NAME: PECONIC CESSPOOL
APPLICANT ADDRESS: P. 0. BOX 972
MATTITUCK, NEW YORK 11952'
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION _
- � 1''tl1' /14W
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
• . OWNER OF PROPERTY: M-- .,/,L 5/3--A,A/C)
OWNER MAILING ADDRESS: S / 9 DA//A-
E--/
/A-
E-/ 'MD c; 10 /9
OWNER PROPERTY ADDRESS: �/f/.3 5/0 -5/ 6-A e--L-2- /Z,•/
7'"/./��G/V[.GAi6 Lt2/
TELEPHONE NUMBER OF CONTACT PERSON: (9-1,---76 $7'
TAX MAP NO. : Section 1 +4I. Block • - Lot -6,
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
11-GZ/A/ie51
Signatur. f Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
w
JOHN SARNO
1350 SIGSBEE ROAD
41
MATTITUCK,
A/6W 04Atiiii 615/MI
0 d iild
�+�
62 Av
2 4
5T404114-
Isre
5/30'
hi /o `