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JUDITH T.TERRYI � y. • Town Hall, 53095 Main Road
TOWN CLERK y 2 P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS1, �,��', Fax (516) 765-1823
MARRIAGE OFFICER L 4,
RECORDS MANAGEMENT OFFICER 'c �4 411 's ����i 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. 1739 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : DAVID W. MCGAHAN
Address 1 : P. O. BOX 602
City St Zip CUTCHOGUE NY 11935
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 #R10-97-0132
Name Of Owner MCGAHAN, DAVID
Mailing Address 1 P. O. BOX 602
City St Zip CUTCHOGUE NY 11935
Property Address 1 STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 7 lot 12.000
Cross Street TRACK AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/01/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
' ' 1
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,o• OFFOL'1
JUDITH T.TERRY i= y� `� Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
• v Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER `�y � Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER .O,,( jit �a011� Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER ,••��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 29, 1997
Transmitted herewith is a copy of application No. 1813 for a Cesspool/
Septic Tank Construction Permit submitted by:
David W. McGahan •
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 re ommendations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
SEP 291997
gnatur
Southold Town Clerk
Dated
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() : : ( j. OE I IIE I OWN CLERK ►()Ic\\`VU(-,i'`�
I own l Southold \� •
hi(1111) Terry, Town Clc t < • ,;.
tc Application 1.1uI
•
Town Hall, 5:1095 Main Road 8 ' constructioncn
P. O. (lox 1179 U, 1 'i;..lpj(
Sunlltcplrl, New York 11971 O1 Alteration
Telephone .( � (f( • Residential
i r ?�»»itt<<
( .itt,) 765 - 1001
Non Residential
TOWN or SOU-[ HOLD
SOUTHOLD WAS-1 EWA TER DISPOSAL I)ISTIZ ICI
API'I_I(:A I ION
I1))
CONSTRUCT ION ut• ALTERA I ION PERMIT
• SEI' I I(: TANK UI (:1'SSSl'OOI.
Pei mit Nu.
Fee
$
•
I)AIf: 2
APPLICANT NAME : '(J ) � f�
AI'Pl.ICAN I AI)I)R1:5S:
SEPTIC ESSPOOL /ykr-e-
1)1:SCR II' I' ION OF 'IMPOSED CONS-I-Rt1C:1 tori OR AlT RAI ION
1 .4041 .i A15 TLNSA
•
LOCA I ION MAI': Must he attached hereto hefore [permit way he Issued.
LOCATION OE PROPOSE[) CONST RUCI- ION OR ALT[ RA'I- ION:
OWNER OF PROPERTY : t C
OWNER MAILING AI)I)R1=SS:.._.....- '. *.__.(,o ..___..cvicttvcAk __..__
OWNER PROPERTY AI)I:)RI_SS : $�L( (,�, '� .1.5.\.)6.-_._....__. .-_.._....___._..__.._... . .
.....
TELEPHONE N WE OF CONTACT PERSON : 93`1 G Z�-D
I AX MAP NO. : Section /b ? Iiluc:ic 7"a< Lot 1
CROSS. STREET : /4'th:
•_
IIl1II.1)IN(; PERMIT Nl1MIII_R CROSS RI:I'I_ : ICE :
.411-1111111111,4:01110111."_
Signal re of Applicant
I(LCLIVI I) DY :
RECEIVED
Town le II('s O((ice
DATE : SEP 2u1997
Southold Town Clerk
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'PARTME? T�OF HEALTH SERVICES .
-YVA�. %9'I'RU('ITON FORA SUFFOLK COUPITY DEPARTMIEUt Of WASH SfAYKCES LOT 2
J14)iLY RESIDENCE ONLY Lv A c p T 1 FOR APPROVAL OF CONSTRUCTION ONLY
, s RBF.No. AI�1��
_ ��_ .' �.. /., Ih4IE —NS REF.NO. a water IMP* And sewage disg
system ke ell; oonfor:
OijC_BEDROOMS ', the Aoudad at the Suffolk Con
EARS FROM DATE OP APPROVAL APPROVED t d t1► service.
i_A S_F • : a • - z
ALTERATION OR ADDITION TO THIS SURVEY ISA VIOLATION OF SECTION 7209 Ok THE NEW YORK STATE EDUCATION LAW COP/ES OF THIS S
;INC THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICA TED HEREON SHAL
PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS T7Ill T7r
', AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE
IR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY d
To MONUMENT THE PROPERTY LINES OR TO GUIDE 77-IE ERECTION OF FENCES, ADDITIONAL STRUCTURES Of? AND OTHER IMPROVEMENTS. EAST
IRFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES A T THE TIME OF SU;
AVAILABLE ❑ WELL WATER ❑ INDIVIDUAL SANITARY SYSTEM ❑ ELEVATION DATUM: A ss SMF_Q_
i 8 CERTIFIED TO: DA vi 0 w Mc.GAHAj
REEN ACRES
?, 1972
ITCHOGUE
HOLD KENNETH M. WOYCHUK L.S.
JNTY, NEW YORK Land Surveying and Design
Aft le/ Calverton, New York 11933
SCALE: 1"=30' DATE: AUG, 14.1997 N. Y. S. UC N0. 80227malnta (516) •) ,y 7 5f12RoD..t J. A.nn ny .