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ELIZABETH A.NEVILLE ����4I ®�'y Town Hall, 53095 Main Road
TOWN CLERK ® - P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® y@ 1% Fax (631) 765-6145
MARRIAGE OFFICER 4 �. �1
RECORDS MANAGEMENT OFFICER ;�®� 4:010• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ��'� southoldtown.northfork.net
OFFICETTOF THETOWNCLERK
SOUTHOLD WASWATSEppR DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2926 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
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-02-0134
Name Of Owner SMITH, RONALD
Mailing Address 1 6320 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 NORTH BAYVIEW ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 8 lot 12.002
Cross Street SEAWOOD DRIVE
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 t0 i•Z- G# : Town Hall, 53095 Main Road
TOWN CLERK % o - % P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �,
Southold, New York 11971
MARRIAGE OFFICER `� y �`��1/, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �,_'*®1 ili . iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ----•-. r�so southoldtown.northfork.net
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� OFFICE OF THE TOWN CLERK
OC 1 2002 d TOWN OF SOUTHOLD
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_ ''.zSoxthold Town Building Department
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FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3045 for a Cesspool/Septic Tank Construction
Permit submitted by:
Catherine Mesiano,Inc. for Ronald Smith
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
i
Comments:
Signature
B��
Dated
OFFICE THE TOWe �N CLERK � ,,,,%9 JLk,���
OF '
TOVN 'QG Application No.30 (fr.
F1.i7ABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 : Construction C/
SOUTHOLD,NEW YORK 11971 vrn,
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Alteration
0
Telephone ��0 � i - $10.00 -Residential
(631) 765-1800 - 1 * �Q
,��' $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$
DATE ) 0115101
APPLICANT NAME: _ CATHERINE MESIANO, INC.
APPLICANT ADDRESS: 12 MILL POND LANE
g "10P!Ct-1FS. NY 11940-1222 -
SEPTIC 1 CESSPOOL / •
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
SF (L
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: PN a hel
OWNER MAILING ADDRESS: (9 0 P.4
OWNER PROPERTY ADDRESS: f\ e ,,nl
.iip( ia'
TELEPHONE NUMBER OF CONTACT PERSON: Tip 5 "40D3
TAX MAP NO. : Section 7 1 Block F Lot 1 2.. I--
CROSS
CROSS STREET: S
BUILDING PERMIT NUMBER CROSS REFERENCE:
/ Signature of Applicant
RECEIVED BY:
W
Tow Clerk's Office
DATE: / /G a--
RECEIVED
SUFFOLK COUNT ► `oma
•
s 2002 JUL I 0 API 11: 34
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s°30ye '1E•PT OF IHFAI_TH SER'V'ICES
OFFICE WASTEWATER MGT
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s / / / APPROVED .. _ .. _ . _ . ".„...104,.•.�.� •
I ,i Vc\I 1\ 0 S��PCK/�� I / // FOR L%A [MUM OF I3L` )OA�fS
/ p J / / - EXPIRES THREE YEARS FROM DATE OF APPROVAL
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RONALD SMYT
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, S.C.T.M.: 1000-079.00-08.00-01
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SCALE:1"=60'
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�E0 PROPOSED In�1 / / DATE: JUNE 28, 20(
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DRIVEWAY
_ �^1 \ / /o^ O JOB NO: 2002-326
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N6 \ \ / / P CERTIFIED TO:
8 04 Q3„ C:,/
\ J/ �3 RONALD SMITH
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TEST HOLE DATA We4n9 , 3 3� It.
FROM FILED MAP b//c /Voter) /
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EL=17 25 DARK BROWN 0 0 /
SANDY LOAM 0 ) (9.4„,.BROWN / ��[
LOAMY SAND
-- 3 0
DAVID H. FOX
BROWN FINE FOX LAND Si
TO COARSE NOTES: PO BOX
SAND SPEONK, N.1
1. AREA = 3.8244 ACRES (631) 325
G W. 2. to = MONUMENT FOUND, A = STAKE FOUND. UNAUTHORIZED ALTERATION OP ,
"NORTHEL=2.05S A Y OLATON OFSECTION 7205
3. SUBDIVISION MAP BAYVIEW ASSOCIATES" FILED EDUCATION LAW COPIES OF TNI
WATER IN THE LAND SURVEYOR'S INKED SE
BROWN FINE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON SHALL NOT BE CONSIDERED TO
TO COARSE MAR. 13, 2001 AS FILE NO. 10583. CER nFICATION INDICATED HEREOI
SAND PERSON FOR WHOM THE SUP JET,
4. ELEVATIONS SHOWN HEREON ARE REFERENCED TO BEHALF TO THE TITLE COMPANY
//A 17.0 N.G.V. DATUM (MSL 1929). ENDING 'Ns TI Tuna,' LTSTEL
ARE1� TS OF E LENDING NST
ARE NOT TRANSFERABLE TO ADT
OR SUBSEQUENT OWNERS