HomeMy WebLinkAboutCullen, Karen 11, iii
,01c FFOL4-
JUDITH T.TERRYy�cs• Town Hall, 53095 Main Road
TOWN CLERK y i P.O. Box 1179
�� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER =y, �N S Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER l �`� d� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1717 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CULLEN, KAREN
Address 1 : 218 STUDLEY STREET
City St Zip BRENTWOOD NY 11717
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 #R10-97-0121
Name Of Owner CULLEN, KAREN
Mailing Address 1 218 STUDLEY STREET
City St Zip BRENTWOOD NY 11717
Property Address 1 9680 NORTH BAYV I EW ROAD
(LOT a OF PELLICANO WOODS)
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 8 lot 13.000
Cross Street
Building Permit Number Cross Reference:
Issue Date: 8/25/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• 1F /WO� / 7 / 7
• „SUf C
0
JUDITH T.TERRY Gyp •
Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
,,,� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS Fax(516) 765-1823 y
MARRIAGE OFFICER �Q 40'1
�I� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER 1 * '1► ��
FREEDOM OF INFORMATION OFFICER otor 4.
„of
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 15, 1997
Transmitted herewith is a copy of application No. 1788 for a Cesspool/
Septic Tank Construction Permit submitted by:
Karen Cullen
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.
Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
a44441774--
Sign u e
S7/1 k? 7
Dated
,OFFICE OF Ill -I-OWN CLERKF�OEx`,O
town of Southold Application No./ 78"a—
Jiidith T. Terry, Town Clerk
Town Hall, 53095 Main Road ` Construction _!
P. O. Box 1179
' � � Allegation
Southold, New York 11971 `�- ---Telephone 4 * • Residential [/
(516) 765-1001 y"Tf Non-Residential
•
TOWN OF SOUTHOLD
SOUTIIOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE -- 7_ - y 7
- --
APPLICANT NAME: --- P12 /"` - - ---_ — -- -- - - -
APPLICANT ADDRESS: _-2 i SA,d/ ,
'�-.-zy 7_____-__
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
-- ------------------
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY :
-_----4,0__- ��1n ---------------- ----------------__----
OWNER MAILING ADDRESS:_ 2/1 Sf(d1 c/ 5Z --`— -- - --_.---
- - __& � T_� Y 2J22 - ------- --
OWNER PROPERTY ADDRE=SS : 96gD fY�r��Z 41(..,2&L-Ag--------------
TELEPHONE NUMBER OF CONTACT PERSON : _ 2_7 : 5'
TAX MAP NO. : Section Block Lot
CROSS STREET : ��' _
BUILDING PERMIT NUMBER CROSS REFERENCE :
gnalur-e of pplicant
RECEIVED BY :
TownClerk's Office
/
DATE: / 6-79
F,, ,, , • •
iDSUFF ..AKCSNETRVICFf ° r_
,Ik?,. :8A R A, YILW •�OapEPT.OFH0' '1191 9lFU�OOtMTYOp!p1TAENTOf HEALTH SEANCES'h ' NOBRIVET _� I � G`• r .•• _ _ FOAPPROVAL•o�V CflNNr ;.**-1'
•
•
JU TB 'A1I 44. DATE
H.S. REF. N0.
• ANIMA Rlikr sw i APPROVED
• I 7 l nAr
•
118ER I1 3*-I THE WATER SUPPLY AND SEWAGE DISPOSAL
TS 6 RESTF9CTIONS . SY31EM4 FOIL TMS,LOT SHALL CONFORM TO
SUB IECT TO CONNf91NN cNOE V 0 I-- THE STAiDARDS OF 1HE SUFFq K COUNTY
i7 DEPARTMENT OF HEALTH SERVICES
n
0 HONED
LOT No. 1 \ \
I \ I \
l
)\'' '''''').,c
S87'5 0'E 518.48'EXIST.
WELL b / .'r140, 3_ PROPOSED 1oDWENGC x DWELLING . 1,104 moot 1000 6,1,,,y, Ep
S
Q t\ TTI„ i 3D0 44.cr OF ' §\
�+ 1- �, ` t° 4/DEWAcc CEAcrirNtr
175.0' 0 �� ?.(kr ` LOT No. 2 CV
PROP. 2.38 ACRES
W 'Qi• 111pL o
0 in •R. \ lt
0 In S.T.
N. L•POP. y�__
PROP.
+ L.P.
Z NOTA CHANGE(S) N
08 sin
N67'52'50''W 519.75'
I LOT No. 4
OT No. 3
CERTIFIED TO:
DK BROWN !b
NOTE: IRJNt1AAY Is Nor s1lowN AND Is Nor LOAM
. POP. PPRMIrTE1 ON SEwA6E O,SpoNAt Sys TCN.
Q BROWN
� ��' SANDY b
PROP.I . . COUNTY OOPAR1TNBrlT'OP HEALTH=AVM LOAM '�
L.P. R•••
S.T.
THE E1f/S1FNDE or RIOR1S or WAY MEOW POINT APPROVALOW PDRA BPALE
ROo w
AND/OR EASEMENTS OF RECORD F d lARO.Y pq,Y TO d
ANY, NOT SHoMN ARE NOT
GUARANTEED. DA"ii< IS - 7. D/010 COARSE 1•
SAND
UNAUTHORIZED ALTERATION OR ADO • AMICWID
TO 779S SU1RIEY IS A NOLATION O
or SECTION
ION 7209
LAW THE NEW voRK STA Q� PALE
BROWN
87CP1t111?NMI MIMSMoil DAT*ofAMIOVA, FINE
ODPIES OF THIS MEW),MAP NOT n
THE LAND SMARWE717R'S NUKED SEAL OR COARSE ,p
EMBOSSED SEAL SMALL NOT BE CONSIDERED SAND
10 BE A VALID TRUE CORE IN
ONLY TO THE PERSON FOR WON TEES INDICATED HEREON�STNPNEY RuN ' VA • AEC110N11111 p WATER
IS PREPARED, AND oN ItS BEHALF TO THE FOR SANITARY 81/sTEIIA
BILE COMPANY, GOtERMVENTAL AGENCY AND • — la a ..J.ll...4.1 ST HOLE DATA
LENDING RVSBTUBON LISTED HEREON, AND
TO RIE ASSIGNEES OF THE LENDING 91511-
WON, GUARANTEES ARE NOT TRANSFERABLE.
SURVEY OF: DESCRIBED PROPERTY
ALSO KNOWN AS LOT No. 2 ON MINOR
SUBDIVISION OF "PELLICANO WOODS" KENNETH H. BECKMAN. L.S.
SITUATED IN: BAYVIEW Surveying and Land Planning
5018 Expressway Drive South
TOWN OF: SOUTHOLD ',,OF NF 9 Suite 202
SUFFOLK COUNTY, NEW YORK
/kit
*SN . X09; Ronkonkoma, N.Y. 11779
yI? ,';1 , f: \ (518) 5e8-o3eo
:* '• `1. *; FAX (518) 467-2041
DATE: 4/7/97 JOB NO. 87-2737 1.i.:,,,,,, 1 •I
DIST. SEC. BLK. �oroea 1 Ngg1
S.C.T.M. NO. 1000 079 08 . a,;!' pU' t
. Ia `"°•