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JUDITH T.TERRY t$ 'yJ► = Town Hall, 53095 Main Road
TOWN CLERKy z P.O. Box 1179
• v' Pr, Southold,New York 11971
REGISTRAR OF VITAL STATISTICS •=
MARRIAGE OFFICER 0��, Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER � ! Ai $ Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER '•• /0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1573 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WALLACE AND GINNY MACOMBER
Address 1 : P. O. BOX 632
City St Zip MATTITUCK NY 11952
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. SCHD REF. #R10-95-0138
Name Of Owner MACOMBER, WALLACE AND GINNY
Mailing Address 1 P. O. BOX 632
City St Zip MATTITUCK NY 11952
Property Address 1 WHITE EAGLE DRIVE
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 9 lot 21 .000
Cross Street PECONIC BAY BLVD.
Building Permit Number Cross Reference:
Issue Date: 11/26/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
O
JUDITH T.TERRY /•• 0 Gyt`� Town Hall, 53095 Main Road
TOWN CLERK
Ce) P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
V6:
� Southold, New York 11971
MARRIAGE OFFICER y� 18%;°.:1;°
Fax (516) 765-1823
RECORDS MANAGEMENT OFFICER .( , �►��sof 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: November 14, 1996
Transmitted herewith is a copy of application No. 1639 for a Cesspool/
Septic Tank Construction Permit submitted by:
Wallace and GinnyConstruct •
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 Z/
DISAPPROVE
/
77
Comments:
RECEIVED /
. /
.�`�/ ....car/-7
N OV 2 5 1996 Signature
/ 'f/‘
(6- Dated
Southold Town Clerk
•
01
OFFICE OF THE TOWN CLERK ,C31
Town of Southold .*4.41• Application No. /60 , 47
Judith T. Terry, Town Clerk �.
Town Hall, 53095 Main Roadtrs Construction
P. O. Box 1179 *.$ Alteration
Southold, New York 11971
Telephone l�; g Residential ✓
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: W&U.,r z- ,rUNoy AAACOt a�1L
APPLICANT ADDRESS:-.60c
jc
?Item`w'JL ►v� I la C a--
SEPTIC " CESSPOOL v
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION . 006-L I✓
cfrAt i l—y �w 1IJcs—
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY: VO! u„FNC t; 4-6-/A)1,-)A- )1..)A levt czyul1L_
OWNER MAILING ADDRESS:54m6 letS / u5
OWNER PROPERTY ADDRESS: LIST ()-I 1AJ1+IT6 e 6-LE 14z.I
TELEPHONE NUMBER OF CONTACT PERSON: , j 9- /D 3 CCcati �Tb�L�
TAX MAP NO. : Section / c,.-7 Block L*j / Lot 0-4
CROSS STREET: - eCCAD(L
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY : /�
Town Clerk's Offic
DATE: l// vig,o
.341 IN .
FILE MAP
LED 8/30/84 +101.60 #10100 f 10045 +100 00
+,c SURVEY 0E
LOT 2/
+0,35WH/TE +/0o.63 EAGL E •100.2 DRIVE 4. 99 56 "
'-c0A RETE CURB _ MAP OF GOLDEN VIEW ESTATES
�.i'_ASPHALTA=3a 4/ PAVEMENT 1� S/TUA TE
' S 32' 331 42 E 148.78'
x.00' LAUREL, TOWN OF SOUTHOLD
I / 100 SUFFOLK COUNTY, N.Y.
=0. pR` ,O1 .
99 `� FILE#7770 SURVEYED FOR WALL ACE DAVID A dCOMBE
FILED AUG 30,984 f GINNY MACOMBER
11
_ • _, }-- TAX NAPi�l000-/27-09-2! .
r ' - PoSEO Lit
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' ' CESS'., !('
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i �a GUARANTEED TO• - r
' WALLACE DAVID MACOMBER F
li' ‘ - GINNY MACOMBER t
0 j 701W4 NATIONAL'TITLE INS.CO. '
ROPOSE0 :.. !I
/// SEPTIC TANK
ZONING R-40
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III;;'' PROPOSED } Q
2,400 S.F. RESIDEIV `i
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,g.'''.. i SEPTIC TANK
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2S GARAGE =o-
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SUBMERSIBLE PUMP
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SUFFO
THE W.-
FOR Tt
OF THE
SUFFOL
FOR A:-
DATE-
Guarantees indicated here on shop run H.S. RE,
only to the person for whom the survey APPRO1'
is prepared, and on his behalf toc the SUFFO
title campcny, Governrental Agency,
lending institi,ticn, if listed hereon, and DIST
to the assignees of the lending ' /000
Guarantegs are not transferable to - -
addifionaPi institutions or subsequent owns OWNER
r W-
1" GI,
Lnauthorized,1,alteration or addition to this TEST
' survey is a 'isolation of Section 7209 of
AS PER Ft
the New York State Education Law. TEST h
t
E Ort
copies of this survey map not bearing —
the Land Surveyors embossed seal shall
not be considered to be a valid this
COPY.
SURVEYED BY:
'R{ SERVICES J. 1SAKSEN,JR.
It.-I . v, :°✓t l+�`tJtVii� 1t P.O. BOX 294
^,.45�,RUCT N� O NEW SUF�OL K.N.Y.,/1956
FOR APAROVAL Or 7`1DENOILY (516)734.-5835 11 i
\ nik 3 0 191HS RV ' •
11)•-9 o� r(,
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APPRo `
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L/CEM�Ej 'NOBURY ►'
DA 't'PRQ�A1. N.Y.S. LI,.%0.149273; -