HomeMy WebLinkAboutEvring, Kenneth 0,„
` oFF04cO
G?`
JUDITH T.TERRY Town Hall, 53095 Main Road
TOWN CLERK ` y = • P.O. Box 1179
. i Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 14r Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER NAM Fax
`t►� �1�' Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER I'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1554 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : KENNETH AND CAROL EVRING
Address 1 : 25 LINCOLN ROAD
City St Zip MEDFORD NY 11763
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-96-87
Name Of Owner EVRING, KENNETH AND CAROL
Mailing Address 1 25 LINCOLN ROAD
City St Zip MEDFORD NY 11763
Property Address 1 280 WAVECREST LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 100.00 block 3 lot 3.000
Cross Street REEVE ROAD
Building Permit Number Cross Reference:
Issue Date: 10/08/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
OgFOLII,c `j 1 "
JUDITH T.TERRY $41 Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
t Southold, New York 11971
REGISTRAR OF VITAL.STATISTICS • $9
MARRIAGE OFFICER
w 1
� �/ Fax(516) 765-1823
�
RECORDS MANAGEMENT OFFICER 0.( �� �1� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER , ,is"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 1, 1996
Transmitted herewith is a copy of application No. 1620 for a Cesspool/
Septic Tank Construction Permit submitted by:
Kenneth and Carol Evrinq •
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: G� — 1154
RECEIVED
0 C T 71996a/
ignatu�r i
Southold Town Clerk ® �
Date
f
OFFICE OF THE TOWN CLERK „, ”"
Town of Southold ��'s �� x�' /6„:26� ,, Application No.
Judith T. Terry, Town Clerk �� �O { Gy
Town Hall, 53095 Main Road •��i' a= Construction �'
P. 0. Box 1179c:3 rTI
Southold, New York 11971 ,' Alteration
•0 $10.00 - Residential
Telephone �o *&0-,'
(516) 765-1801 _ 1 ,�, ' $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$ as
DATE D ,& � DE ,C /./ /to
APPLICANT NAME: /(•e/U/(/i7N e7- en ea X. E
APPLICANT ADDRESS: .2S' (ti 12.4. me.cicor-c IV.`/, I i•
767
SEPTIC ✓ CESSPOOL f/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
b' Irl G o/ S rie ve77,04/ Ic-c f'E 4 /'fi/e /f o1
svPP otik eoun/r'Y 1?a,q4. J oP &Eft/A.7'
LOCATION MAP: • Must be attached hereto before permit may be issued. G?p/') o�
S / 1/6-Y
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: HE iiV G 7"}/ a C,4,Cv'
OWNER MAILING ADDRESS: ...ZS' L/-. Co/ti /2/ ne/y,-r/ / / ?4,3
OWNER PROPERTY ADDRESS: S'O (.,t)aCrecl.
IA? T'1'c '1`oc/C /1.4
11,
TELEPHONE NUMBER OF CONTACT PERSON: 576
Dl S7LlQo0
TAX MAP NO. : Section /do Block 3 Lot 3
CROSS STREET : Ree-ve
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
-
Signature of Applic t
RECEIVED BY : ' /
Town Clerk s Office
DATE: Ril �J Cs•-
It , *- SUFFOLK CO.HEALTH DEPT.APPI'
.nom • t
1d i I+rLtif}= 5A1`
r
1
R 4
s r t o r a
WAVECt2FST .oril
ri 0
o
C,.� + O o
s7CCtlT=Q C
t
_�.!�EEVE ROAD ;int L 4ti;E 5C• �n O ..
r
•
z el
%
` t
i � .. `S1,?H
O
fl
ii ,7, ,'i —
_ . S Ets o\ PER c ye {{ p(
__Nrr .f s— 0
I , � m
rn
i . ,
y •`s " 11
MAP PRPE ' x Q c' �` _ SUC�VE`EED2 r 09- xi o •
� ar g ;t
'-2ST :a a.
i SUFFOLK CO. TAX MA• .. :
'V,,E a lit T i• r i. AT DIST. SECT. BLOCK PCL.
y - OWNERS ADDRESS:
, v rOrr0. QF SDUjfQ .D KY,
szPrrrt Sys. TOW?�1
� ui 42` F X F��L
-,, . ("ap-R.4 -
} DEED:L KVA P.
ii3
Z I to TEST HOLE STAMP
_ �t--
in inis survey Ism violadeo of
;4 ALE' 'i� —+ 3aclbrn 7108 of the New gryy.
C p'4 Education lett
:- C h
,.. s i,S'' AREA a G .!Ci 0 Z'rn .'' r. Copies o:!hie eurveY meu not!ma'am 8"
- - - # - - Me fend su feyofehked sca o
P U w 'tQNtlt Eh3T h.em=nw,d
LUT
embossed sw
>•beeveid tn,a
�' _ - { Aoararnws fret meed hereon shed r-,
- .-_..—__—..—
t --._. _. eery to the memo tus whom the sway
:i" - - :propend.and on his Pollee to the
company,gotemanerttal epency WO
L f f +eIta*nding insmutton fisted harem and
A 1:4E Ata ED 5 E.f�'f_ O.j 99_6 to Pm assignees of the lend inn
I — ••••. CMJ,
_ --- -- - P .cue, ces are nottransferawe
^
LU to ad:..;nal nuau:wns orsuosar4ur„rd
-
es- SEAL
a3 y a * - ..
'.C)fNOS.REFEITO h'AP OF SALAt2E EST' PILE:
1N `#-4ESUFF.c3.CLERJ�''SOFFICEAS AS, URV 5 �t coq 4F.,-.vg,
_,. r - MAF c c 2f 6 �
L-`tirES3 FT !
�i ;: RODE VAN TC7_Yj.P,C * ` w4A
� LICENSED LAND SURVEYORS r 1: &
ri ate. �.
.v :• GREENPORT NEW YORK
lass mato