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JUDITH T.TERRY �� Z1 1 Town Hall, 53095 Main Road
TOWN CLERK % y i P.O. Box 1179
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•. 417
3.- Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER �� �� �O� T
I.- Fax(516) 765-1823
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Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
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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. 1750 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JOHN AND CATHERINE MCDONALD
Address 1 : 12 HASTING STREET
City St Zip DIX HILLS NY 11746
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 #R10-97-0133
Name Of Owner MCDONALD, JOHN E.
Mailing Address 1 12 HASTINGS STREET
City St Zip DIX HILLS NY 11746
Property Address 1 WUNNEWETA ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 12 lot 12.002
Cross Street VANSTON ROAD
Building Permit Number Cross Reference:
Issue Date: 10/10/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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75
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JUDI T.TERRY IL
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TOWNCLERK , OCTy 9 .O. Box 1179
0 ' So .tho .,New York 11971
REGISTRAR.OF VITAL STATISTICS
MARRIAGE OFFICER ``y* �� T+ y F: 4 (516) 765-1823
RECORDS MANAGEMENT OFFICER 01 � AVTIOl 'j"' ''' -I- iI.•'• _t•le•h ne(516) 765-1800
FREEDOM OF INFORMATION OFFICER -... vi"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 9, 1997
Transmitted herewith is a copy of application No. 1824 for a Cesspool/
Septic Tank Construction Permit submitted by:
John and Catherine McDonald .
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.
4-A- t-ot c2.—
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE
DISAPPROVE
Comments:
Signat
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Dated
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t/FFICE OF THE TOWN CLERK )1/14\V 110- -
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Southold, New York 11971 '4 ' ., *- •)Ve $ 1,1( •
Telephone • Residential
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(S16) 765 - 11101 Non Residential... . .. _
TOWN OE SOUTHOLD
SOUTHOLD WASTIEWATIER DISPOSAL DISTRICT
APPLICATION
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CO N ST RU CT ION or ALTERATION PERMIT
• SEPTIC .I.ANK or CESSPOOL
Permit No....___............. ...
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Fee $ ... _ . ......._..._.;
DA FE ,001-4,. f fl 7
APPLICANT NAME: J.---04" ql--- ather/A-e We..0o 4/9/d
APPLICAN I. ADDRESS: X910157//4, 5/'1---
SEPTIC CESSPOOL V---- ,
--------• ---------
DESCRIpT to N OF PROPOSED CONSTRUCTION OR ALTERATION___________......... ....
- -- •----- - .........--______PAze fa 42 ,6 •ee.S5ro a C ' ' ev.e_
PAR_ 4/0_714: 744/A- ' .
LOCATION MAP: Must he attached hereto before permit way he Issued.
LOCATION OE PROPOSED CON sI.RucT ION OR ALTERATION:
OWNER OF PROPERTY : N=t0-4./ 1-----7 (.101, en.--Le--elt-A.L--.4_,,
OWNER MAILING ADDRESS: 061/45frAl S /---
., /,›C A74-• If/ . / t 7 Li
OWNER PROPERTY ADDRESS: cticl.,1,4,eCUTC-140
TELEPHONE NUMBER OF CONTACT PERSON :
FAX 'MAP NO. : Section...JO:L. . . .11lock.... _42 .
CROSS. STREET : Ci .4461-6-74 .
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BUILDING PERMIT NUMI3Eit CROSS REFERENCE : 1
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pia,4/fOi •
Signature of Applicant
RECEIVED BY : Ak....)'Cl)--/C--- . . .
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GRAPHIC SCALE 1"=40' 4
MI MI MN ��■ SURVEY OF PART OF LOTS 203 AND 204
EN in �� immin...
0 40 Bo 120■ AS SHOWN ON "AMENDED MAP A, NASSAU POINT"
• .0 cO[JNTYDEPARTMEIrR OF HEALTH vides .��`�' , AT NASSAU POINT,TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
• • i FOR APPROVAL OF CONSPRUCTIOjV. A 1
IoINGLE FAMILY RESIDENCE ONLY • c1-
DATE 0 I Rlo '9't --O\33 100' RPM CP E�`29•5 GRADE
SUFFOLK COUNTY TAX MAP NUMBER
APPROVED .�Aj 4---_._ !, — —/� — --TEST 1000-10400-1200-012002
WOM
FOR i iUMOF BEDROOMS / Y� HOLE % \ E1-`�''� GUARANTEED TO: UMW 94
/ O�''" \� JOHN E. McDONALD &
EXPIRES a YEARS FROM Dl�TWOFA'�fPR• 4?-'O /‘4) \\ CATHERINE T. MCDONALD
`��� / / JPJ .\-- \\ \ irD3 SURVEYED AUG. 13. 1997
/ / ��0 G �� \ sw MODIFIED SEPT. 13, 1997
0 PP A \ \ MODIFIED SEPT. 29, 1997
Y F' 20 Ils •` N \ NOTES: PALE MOM
// / �OV .\,9,‘ z,<,„ LO \ ■ = MONUMENT FOUND FINE
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I— 7 SSP /25010 ,I \1 ---� SUFFOLKELEVATIOCOUNNS TY E TOPORMAPSD TO
7,�E�1 I '\•C.- u)
/ e � so. r- n I I • LOT NUMBERS REFERNECE
O� I i\' \ �l O I "AMENDED MAP A. NASSAU POINT"
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FILED IN THE OFFICE OF THE CLERK
��P \ fn / I OF SUFFOLK COUNTY ON 17•
/ ,goo L137.2. -�� I
AUG. 16, 1922 AS MAP NUMBER 156 TEST HOLE
/ CL34• �2\\ \ / / �VACANj) 100' SEPARATION REQUIRES A WELL mc DONALD GEOSCIENCE
/ E1 i9\ \ �1 'a g9 \� LO / / 2O4 RECORDS ATHEAD 40. NTHE TO GHEALTH WDEPT. SHOW
/ \�\ \ ��09 mss 1 / NEIGHBORS WITH SUCH WELL DEPTHS.
I �- \ \ It -99 o 1 ,O� / / PREVIOUS APPROVAL #R10 97-0133
I �� �Q FOtS / /
FA \ O y�9�Fp 50 z.
PDQ \ tIN / / 0• _-- mapeaaring a alteration
surveyor's sealuisea
.I Z wE1-1- �." y I LOPE / 6\-_-_____-- violation of section nog, Butt-division 2, of the
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1 j/. 1!,' O Ln•E p COP' 'Only copies from the original of this survey
L//,�(� \J fj � �N� �� PA- mortal with an original of the land surveyor s Tm
O � g0 „ Cstamped 00 Nal sMll as considered t0 Dt volftl true
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N" Q' 'Certifications indicatedac hereon signify that this m
3 ,' / O' r N O� survey was prepared in accordance with the ex-
isting
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.Le `� 6 ,`-' 'O o �, iyt the tone of Practice for atio SurveysPadoptedi '�C' p� '((
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n by the New York State association of Professional 1.1
\ 4/ (" g• 20 Tr-f Land Surveyors. Said certifications shall run only m .
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