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ELIZABETH A. NEVILLE �s �'y� Town Hall, 53095 Main Road
TOWN CLERK % o - P.O. Box 1179
Southold, New York 11971
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REGISTRAR OF VITAL STATISTICS ) yC � Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER �,_ ®1 . ,i• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,- �� southoldtown.northfork.net
OFFICE OF THETOWNCLERK
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2914 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CATHERINE MESIANO INC
Address 1 : 12 MILL POND LANE
City St Zip EAST MORICHES NY 11940
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner PALMERI, CAROL & R ROTHBERG
Mailing Address 1 55 WEST HARISDALE AVENUE
APT H
City St Zip HARTSDALE NY 10530
Property Address 1 4355 ALDRICH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 112.00 block 1 lot 13.000
Cross Street SOUND AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE i, ®4Town Hall, 53095 Main Road
TOWN CLERK o •
P.O. Box 1179
1 N 2
REGISTRAR OF VITAL STATISTICS ,„„„ft Southold, New York 11971
MARRIAGE OFFICER :®,�i .•/ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �__�®1 ��®��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK / ULK,,:-- 30 3 2
TOWN OF SOUTHOLD ��� Oli Application No.
ELIZABETH A.NEVILLE,TOWN CLERK : '
P.O.BOX 1179 • 1.; Construction
SOLTTHOLD,NEW YORK 11971 =v T
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cn Alteration
Telephone A0 �Q�f` $10.00 -Residential
%(637:) 765-1800 = l * , �' $25.00 -Non-Residential
TOWN OF SOUTHOLD •
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SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION •
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for
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CONSTRUCTION or ALTERATION PERMIT ,
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE ?/.2'do 2_
APPLICANT NAME: CATHERINE MESIANO, INC.
APPLICANT ADDRES: 12 MILL POND LANE 1 EXT.
E. MORICHES, NY 11940-1222 •
SEPTIC 'CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CON TRUCTION OR ALTERATION:
OWNER OF PROPERTY: (Ara ,ai�Y�
�do m, ,mss
OWNER MAILING ADDRESS: 55 7 L7SOR-4g ,�"y,� - 4,4„
, Al y l D 53-0
OWNER PROPERTY ADDRESS: 1(3 5 5 A/A ./,C H 21A" (51‘.
MA-7r,TvciC
TELEPHONE NUMBER OF CONTACT PERSON: f7f-69f5i (C, /y)es
TAX MAP NO. : Section -//�-' Block /- - Lot 13
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• CROSS STREET: 300 ,1)_/) ►4 v _
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
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i SUFFOLK OOU4'Y DEPARTMENT Otr nEAL'CH SEiiVICE
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1 PERMIT FOR APPROVAL OF COZTRUC CION FOR A ; +
• N LE FAMILY RESIDENCE ONLY i
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DATE � 1
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FO1 N CI UM Or 1•._.BEDROOMS
EXPIRES THREE YEARS FROM DATE OF APPROVAL
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