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Nicholas, A E
ori Aro. /OlSVFFOL `'C� .. • JUDITH T. TERRY �' 4 Gym Town Hall, 53095 Main Road TOWN CLERK o P.O. Box 1179 T t Southold, New York 11971 REGISTRAR OF VITAL STATISTICS O 1 Fax(516) 765-1823 MARRIAGE OFFICERAGEMENT OFFICERO � I,�� Telephone(516) 765-1800 FREEDOM ORECORDS F INFORMATION OFFICER _ ""•••• ���' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1612 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : A.E. NICHOLAS Address 1 : P. O. BOX 569 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. #R10-97-0011 Name Of Owner NICHOLAS, A. E. Mailing Address 1 P. O. BOX 569 City St Zip MATTITUCK NY 11952 Property Address 1 HALLOCK LANE City St Zip MATTITUCK NY 11952 Tax Map No. section 112.00 block 1 lot 8.008 Cross Street ALDRICH LANE Building Permit Number Cross Reference: Issue Date: 3/20/97 Judith T. Terry Southold Town Clerk (TOWN SEAL) • o°,o' FFOL,tc /6, r/ Q� �G. JUDITH T.TERRY �•_� y<\� Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS .r 44, r. �� Southold,New York 11971 � Telephone5 MARRIAGE OFFICER Fax(516) 76 -1823 RECORDS MANAGEMENT OFFICER �: •I � `1►• e1 (5 6) 765-1800 FREEDOM OF INFORMATION OFFICER '•v• ''.° OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: February 14, 1997 Transmitted herewith is a copy of application No. 1669 for a Cesspool/ Septic Tank Construction Permit submitted by: A.E. Nicholas • 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. 4eAto_c: Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: RECEIVED MAR 2 ' 1997 Signatu 3 ,,j97 Southold Town , 7_r Dated T OFFICE OF THE TOWN CLERK goo ""•., Town of Southold ele �F�ou�C Judith T. Terry, Town Clerk �'� ��.,, �iO��` Application No. /44? Town Hall, 53095 Main Road r Construction x P. 0. Box 1179 ca rn = Alteration Southold, New York 11971 tn Telephone : '70 ��� $10.00 - Residential (516) 765-11301 > f` $25.00 -Non-Residential •• , •rt TOWN OF SOUTIIOLD • SOUTIIOLD WASTEWATER DISPOSAL DISTRICT . APPLICATION for • CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee .$ DATE October 16, 1996 AN1 — APPLICANT NAME: A E Nicholas ) Na 14 CV APPLICANT ADDRESS: PO Box 569, Marriruck, NY 11952 SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 'f.F(..) \A/c?-c3.1 . LOCATION MAP: • Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY : self OWNER MAILING ADDRESS: same, or 216 West 89th St. NYC 10024 • OWNER PROPERTY ADDRESS:_�lallock L e, Mattituck. NY 11952 4/2 �(o7 Ro3, TELEPHONE NUMBER OF CONTACT PERSON: oZQ6----Yd TAX MAP NO. : Section s41 Blocic /1 2. Lot J .- CROSS CROSS STREET : 14 1 A_, r I crU2 BUILDING PERMIT NUMBER CROSS REFERENCE: F r Cv Gt.a� Signature of Applicant RECEIVED BY : Jd ) Town Clerk's Office DATE: f/ x/797 I SLA -1 41INo' .. 0 Zea NG DUN O N53.04.00 SURVEY OF uk .. PROPERTY �M '`�/ "q A T MATTITUCK a/ , N ,t • = TOWN OF SOUTHOLD Z SUFFOLK COUNTY, N. Y. 1000- 11?-01-8.3 t. s ' Scale : 1"- 100' A �t i Jan. 25, 1997 lk e/d"/` \ iii e/ 4 S < iA 700111 R 1 O - — 1 I am/aeAr rah!M STAAWARDS FCW APPROVAL >s r l AM CONSTRUCTION OF SY,MSFACE'SEWAGE' ros \1'^•' , N "P DISPOSAL SYSTEMS FOR SMILE FAMILY RESIDENCES 7), end d SMde by Me conhWsns set IorM Xenia ad on The /i�A.�r�: �i T3 an X Dia To construct i • tr� N i j Z1 O \ N. •Q N\• TM locations of rens end cesspools 1shoen hereon ore Nomfieldobservations o . end or born dole obtained Irom others. 1 I o 0—A ti M/ QN /I / t• .' I. 4 ., 3_O_ J .....„.,a,. : .,�,..., rf.' ... .�- w-ac:+: ,».�r^!nrse�a»�. >+� ' ie �s• • © moN ,� , or �•,• . 00. 350' - - z v' / IA \ ,. E. pri 0 itie $o \i.N• 2 '' /' r' / a-' 11[ /11• 5. t •`Ile // ! VA1100 ' um s e -0011 O 5 �' AfRW/D eI 's o+^ • DAIS c',/ ,, , !OR pR10yl � 603* or' s v, r vat It 4 a . d v a`a 0 cwt. of .1t' F�'+� a� G.63hZ00 1'0 1 LOT NUMBERS SL/IRO/VISION MADE F01?CHARLES _ D TO �ee 4 P. SIMMONS*AND FLED IN TIE OFFICE OF p��,;r i •`V� THE SOUTHOLD TOWN CLERK f Of Nf CONTOUR LINES ARE REFERENCED TO S 0.1.Matt 041t, . AREA = 10.795 Acres EASTERN TOWNS TOPOGRAPHIC sir, A 'A to tie line )� ..,- 63 * AMI >ou7tnnww a�'a°7rn�r+i►i°a�r a atmAlu�s A►aLA h'j•• 5. LIC. NO. 4S►6/B T MCMMv�oo1li t�r SOUND AVENUE MSM.O DESUDEOR P. O. D��� roe J/ AIi 7V CORY MIN SW if 71E 'Ammo Sr • u If I/11i1gMf 1230"„ • R STREET MUST' NO rows DEN AS A yen