HomeMy WebLinkAboutRivera, Christine 011' FFOL,jc
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JUDITH T.TERRY t��� G'1J►� Town Hall, 53095 Main Road
TOWN CLERK 1 o P.O. Box 1179
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\ �y T t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS � Fax (516) 765-1823
MARRIAGE OFFICER .**RECORDS sigaO�/,�� Telephone (516) 765-1800
FREEDOM OF INFORMATIONNOFFICER NAGEMENT OFFICER1 '
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1693 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : CHRISTINE RIVERA
Address 1 : 22 WILLETTS COURT
City St Zip ROCKVILLE CENTRE NY 11570
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. #R10-96-0023
Name Of Owner RIVERA, CHRISTINE
Mailing Address 1 22 WILLETTS COURT
City St Zip ROCKVILLE CENTRE NY 11570
Property Address 1 250 SOUND BEACH DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 1 lot 16.000
Cross Street INLET DRIVE
Building Permit Number Cross Reference:
Issue Date: 6/26/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY 11•=0 cot Town Hall, 53095 Main Road
TOWN CLERK Cl) - P.O. Box 1179
Pry � Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O
MARRIAGE OFFICER y
�� Fax(516) 765-1823
RECORDS MANAGEMENT OFFICER
491
FREEDOM
� � Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER = ,i���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 20, 1997
Transmitted herewith is a copy of application No. 1763 for a Cesspool/
Septic Tank Construction Permit submitted by:
Christine Rivera
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 recoommendations:
APPROVE
DISAPPROVE
Comments:
RECEIVED
JUN 2 4 1997
nature
Southold Town Clerk �- 9 I
Dated
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OFFICEOF THE TOWN CLERK ''c.31fOt -e.
Town of Southold ��� /7 3
Judith T. Terry, Town Clerk Application No. ___ _
Town Ball, 53095 Main Road 8 .. Construction
P. O. Box 1179
`" ��� Alteration__
Southold, New York 11971 Owe
Telephone �1 �� Residential-------------
(516)
—�__ _ — _
(516) 765-1801 "r' il Non-Residential
TOWN OF SOUTHOLD
SOUTIIOL.D WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC: TANK or CESSPOOL
Permit No.
Fee $
DATE 6 070_ 97
APPLICANT- NAME: _/Si/ ,v� _(7 e/a
APPLICANT ADDRESS: c:,-5-es -�+'/n�--- A. ----.------- -`--- `---
SEPTIC CESSPOOL •----
DESCRIPTION
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERAT ON
�jry) 4,,-,4,
. -.--__ __--__..... _ -.-_.---_- w_,2 __.. �-.-.. - .-. __._-----•_•_•_•__-._--.-. .-___--__.-_-.- -- .. -..-
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR AL ERATION :
OWNER OF PROPERTY : �t isriNb lde,t--
-- --------------- ---- ----- ----- --------- ______
OWNER MAILING ADDRESS:�o2 //e14As de
OWNER PROPERTY ADDRESS:-0250 _Sou., r
TELEPHONE NUMBER OF CONTACT PERSON :_L5/6__ 7GG ea Y-7
TAX MAP NO. : Section— 9 lD'i __--._ _________________ ---Lot_/(�, _ — --
CROSS STREET
BUILDING PERMIT NUMBER CROSS REFERENCE :
rgnature of I plicant ^
RECEIVED BY :
T_ _
--- own Clerk's Office
DATE:
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ANY AL TERA TION OR ADDITION TO THIS SURVEY ISA VIO-A
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, .
FOR APPROVAL OF CONSTRUCTION ONLY• EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIF7CArk
HEREON ARE VALID FOR TINS MAP AND COPIES THEREOF ONLY It
SAN) MAP OR COPES BEAR TIE IMPRESSED SEAL OF TIE SURVEY
WHOSE SIGNATURE APPEARS HEREON.
•
r DATE HS. REF. NO. ADDITIONALLY TO COMPLY WITH LW LAW THE TERM 'ALTERED E
r/.
MUST BE USED BY ANY AND ALL SURVEYORS UTLIZWG A COPY
*OF BROUGH ANOTHER
O-DATE ARE NOT NV CEO PLIAI,ICE WITH THE LAW.RMS SUCH AS , At
APPROVED
I am familiar with the STANDARDS FOR APPROVAL {N
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES 47" �h,�bQvt ��ae+ca al g.3'
and will abide by the conditions set forth therein and on the -� ,l 9.1
permit to construct. _ .._._____. ..-----. I'm',"G q/IrPairi 4•
I E.7.+ LE " /000 9a./ -17-d . . ,e eOo,o/✓!V/r
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PLAN SEPTIC SYSTEM
c-.)O.
T .
EXISTING SEPTIC SYSTEM TO BE FLLED
IN OR REMOVED
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SURVEY OF
J .,. LOTS 61 , 60
-� MAP OF
r " CAPTAIN K/DD ESTATES "
el ' . c FILE NO. 1672, FILED JAN 19, 1949
...\ AT MA T TI TUCK
TOWN OF SOUTHOLD
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0- . v SUFFOLK COUNTY, NY.
r 1000 — 99 — 0 1 — 16�
0 ,, Q SCALE : 1" = 20
v� 13 JAN 9, 1995
n�' �� Dec. 28, 1995 (TOPO,GRAPHICAL INFC
4 Mar 25/ l99G..( /)re'p. a.c:xd/71/0r0
�`� ��� al �' " 4 June ll, 1996 (SEPTIC SYSTEM
IA CC\
,.\ t%* LOT 0
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/sIrLir �' �' e� SUFFOLK COUNTY DEPARTMENT OF MALTA SERVICES
1.1", - \� PERMTI'FOR APPROVAL OPcONSTItUCTION FOR A
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MINGLE FAMILY RESIDENCE ONLY
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el \ !.° 6 �y EXPIRES THREE YEARS FROM DATE OF APPROVAL.
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