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ELIZABETH A.NEVILLE $�� y.
Town Hall, 53095 Main Road
TOWN CLERK ; p �- P.O. Box 1179
REGISTRAR OF VITAL STATISTICS • 0 ',1 Southold, New York 11971
MARRIAGE OFFICER •` y Fax (516) 765-1823
Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER — 1 1���
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1823 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DIANE HEROLD
Address 1 : P. O. BOX 884
City St Zip WESTHAMPTON BEACH NY 11978
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.
Name Of Owner POWERS, KRISTEN
Mailing Address 1 12180 BRECKNOCK STREET
City St Zip OAKTON VA 22124
Property Address 1 220 PARK AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 126.00 block 8 lot 26.001
Cross Street
Building Permit Number Cross Reference:
Issue Date: 3/13/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE I, ° ...y % Town Hall, 53095 Main Road
TOWN 1 ° ..% 1 P.O. Box 1179
4 c/3Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS • v' /I Fax (516) 765-1823
MARRIAGE OFFICER q2. ��0.01 Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER /10
FREEDOM OF INFORMATION OFFICER are ��ge
OFFICE OF THE TOWN CLERK ; 3
TOWN OF SOUTHOLD
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TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 12, 1998
Transmitted herewith is a copy of application No. 1897 for a Cesspool/
Septic Tank Construction Permit submitted by:
Diane Herold for Kristen Powers •
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:
)ignatu
Dated
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OFFICE OF THE TOWN CLERK cF1/00-,,,-
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Town yf Southold
Judith T. TehA
-y, Town Clerk .--c. It Application No. ir7:17
Town Hall, 53095 Main Road 8 - Construction
P. O. Box 1179 --t-- - ------
0 ' . : *-$ Alteration
Southold, New York 11971- 4, yOoe Residential I/
Telephone -'. _, A 0i 4 r‘iff
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(516) 7651801 Non-Residential
TOWN OF SOUTIIOLD
souTnoLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
-------
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE _ MORN 1.0_, R q 8
APPLICANT NAME: NDLIkiX._ R.E.R.01-1fkkC1416..c1
APPLICANT ADDRESS: 1) p s, ,a, cis/
(AL6s-t HJ\vinP700. erAc Iri. AIEW YOILlt ISM
SEPTIC / CESSPOOL ‘/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY : ms-1,60 ?Dwells, Q.00-120.c.7 uej):DISC%-_
OWNER MAILING ADDRESS: (z1 So F5(2.Ectivock. SifLe.ei
__ctAk_700.i. Vitl..61 NI A ZZ 1-2-Y
OWNER PROPERTY ADDRESS: zzo voka44. _kudijo6
rA Pa. 7/10de...
TELEPHONE NUMBER OF CONTACT PERSON : 7_138-50qq,
TAX MAP NO. : Section 12,- Block 8 lot z6. 1
CROSS STREET : Aioue.
BUILDING PERMIT NUMBER CROSS REFERENCE :,fuev kr sAme Thil4-
Las;¢. 11441
Signature of Applicant
-
RECEIVED BY :
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Lewn Clerk's Office
DAT E: /72i
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SURVEYOF FLOATING WOOD DOCK
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MAP OF
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FILE No. 331 FILED MARCH 19, 1927
SITUATED AT
MATTITUCK 44°
TOWN OF SOUTHOLDRI AL AL
SUFFOLK COUNTY, NEW YORK
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TITLE No. BAM 18488
OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY `v v7
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PREPARED IN ACCORDANCE WITH THE MINIMUM O -�[J
STANDARDS FOR TITLE SURVEYS AS ESTABLISHED O i0," 0,.fin' TOM
BY THE LIA.L.S. AND APPROVED AND ADOPTED O ., if 2"'
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FOR SUCH USE BY THE NEW YORK STATE LAND O, kliA
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'9T '_a�T11'''_: �Q N.Y.S. Lic. No. 49668 cn� cfl 1.21E _t _ cnE u
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UNATHORIZED ALTERATION OR ADDITION A __�_ R aNs W000 BUUCHF�'D *• '
TO THIS SURVEY IS A VIOLATION OF • ��
SECTION 7209 OF THE NEW YORK STATE ' W
Joseph
oSeh A. i nen` EDUCATION LAW. ____________----- are
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Land Surveyor THE LAND SURVEYOR'S INKED SEAL OR SI
EMBOSSED SEAL SHALL NOT BE CONSIDERED N
TO BEA VALID TRUE COPY. ••
CERTIFICATIONS INDICATED HEREON SHALL RUN P
ONLY TO THE PERSON FOR WHOM THE SURVEY o '
IS PREPARED, AND ON HIS BEHALF TO THE ,
TITLECOMPANY, GOVERNMENTAL AGENCY AND g �t 7
Title Surveys - Subdivisions• - Site Plans - Construction Layout LEND
ING INSTITUTION LISTED HEREON, AND � 1(1
TO THE ASSIGNEES OF THE LENDING INSTI- lvC
PHONE (516)727-2090 Fax (516)722-5093 TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. Q 0�
OFFICES LOCATED AT MAILING ADDRESS 1
THE EXISTENCE OF RIGHTS OF WAY �NryOne Union Square P.O. Box 1931 AND/OR EASEMENTS OF RECORD, IF G�
Aquebogue, New York 11931 Riverhead, New York 11901 ANY, NOT SHOWN ARE NOT GUARANTEED.
97-414A1