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JUDITH T.TERRY tI � Gym•�� Town Hall, 53095 Main Road
TOWN CLERK o = P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICS O
MARRIAGE OFFICER N #4, 00-jig � ��
RECORDS MANAGEMENT OFFICER 1 4' Fax (516) 765-1823
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FREEDOM OF INFORMATION OFFICER �� Fax
(516) 765-1800
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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. 1672 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : AFC CONSTRUCTION
Address 1 : 68 SMITH STREET
City St Zip EAST MORICHES NY 11940
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. #R10-97-0081
Name Of Owner RIBEIRO, JOHN
Mailing Address 1 68 SMITH STREET
City St Zip EAST MORICHES NY 11940
Property Address 1 FARMVEU ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 121 .00 block 7 lot 12.000
Cross Street HARVEST LANE
Building Permit Number Cross Reference:
Issue Date: 5/15/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
ft7 *Is
,. MAY - 5 1997
,
• B i Town Hall, 53095 Main Road
• y P.O. Box 1179
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BLDG. DEPT. 1 1 Q � �
,Tt'/N 0F SO, #fir Ih \ n �.�0 Southold, New York 11971
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JUDITH T.TERRY , �,K/1 — TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 5, 1997
Transmitted herewith is a copy of application No. 1741 for a Cesspool/
Septic Tank Construction Permit submitted by:
AFC Construction for John Ribeiro •
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:
RECEIVED ?
MAY I. 1997
Si nature /"
'" 11° Date 9
Southold Town
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OFFICE OF THE TOWN CLERK ,VF4'
FU ,
Town of Southold \�� COG=
Judith T. Terry, Town Clerk Application No. 7 q/
Town Hall, 53095 Main Road ` j Construction
tri
P. O. Box 1179
Southold, New York 11971 ;, Alteration
0-1.0
Residential
Telephone 1
(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 $ �y►
DATE rn?AV S , / g97-
APPLICANT NAME: /4 C C6A/S7',LULT7 oma/ Foe_ s--70/-111) R e/leLO
APPLICANT ADDRESS: 6g S, j 97-
5/1 Jr M6,4 afEs A/att Vole k. e()
SEPTIC CESSPOOL ✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
<.Slil6t (ni/1y ReSIic'vGC — /UeJ CoAvsTlzv 77 01A)
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: jo14 AJ R 18 el-
OWNER
OWNER MAILING ADDRESS: 6E- ,Stki / 1-74-
ER sr in
-74-CRSr/Yl rc/fCs, /(/Y /(9/C)
OWNER PROPERTY ADDRESS: La T ici91244 V RO/41p
in 4777 7V C /(/evv /pet<
TELEPHONE NUMBER OF CONTACT PERSON: 5/6 E7i{" 3e6s-
TAX MAP NO. : Section f,2) . 00 Block 0/ , 00 Lot 0/2 000
CROSS STREET: J-RV t S I (k
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of • p.licant
RECEIVED BY:///
Town Clerk's ice
DATE: 73-7/ ;7
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A R E A s 4 I�2.80-5.F. NOTES:
Assumed
• • •r t 2. S C.T.M Lot Numbers shown thus: r..,
,° H 1 9 40 30 W 1 tDD.DO J Filed Map Lot Numbers shown thus:(..;
_ h 4 Existing Elevations stwwn thus: 1*'ti-
�T• \/ S. Maximum fertilizer dependent vegetations is
•
limited to 15%of the lot area.
t+ • r 1 r tl _ .— 4Oi (•. For Test bottni sea.filed 4N
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SUFFOLK OUNTY DEPARTMENT OF HEALTH SERVICES
Rio q co
t A I =,.,.,,t I FERMI APPROVAL OF CON 'TUC!IDN FOR A
-� airaaR."�' ��.r
� . 1 C,I;l"4'.^L�ILi T:ESIDE NCE ONLY�. z►`a'as. DATE,q b.A .�!_ i R' If) (_,(2,...--,?..7,...:L20sSl
_ SECTIONS —...._._
)'O,;&;4.';‘......''t.'•-.i i.,°:?(A.'_1...,.Z _ .'::... ' ''b.:
•. T ; TnPtCAt RECTANGULAR SEPTIC LINK F•X.PI:i:-i 't::._�:.i: t.E...R:.Fz:i. ;�'i!...%.,:t. '',;:i.;;; ".J'`i 0V/cca..
I....Y wilts all OM t.s w••r0
TYPICAL LEACHING POOL SURVEY OF PROPERTY AT:MATTITUGI ,
TCNVN OF:SDUTHOLD OOUN 1Y CF SUFFOLK, N.Y.
UNAUTHORIZED ALTERATION OR ACOIT10N TO SSURVYISA7ISA FILED MAP 14°. ebeoe MAP OF:FA2MVEll ASSOCIATES
VIOLATION OF SECTION 7209 CF TIE NEW YORK STATE EDUCA•
TION LAW, FILED-L- SEPT ot, t9A9 SURVEYED FOR:,T014 N Rl BE 1 R 0
CONES OF THIS S*NtY MAP NOT BEARING ME LANE) SUfVENCf1S
INKED SEAL OR EMBOSSED SEAL. SHALL NUT BE CON;,DE1,ED TO CERTIFIED TO
BE A VALID TRUE COPY.
GUARANTEES INDICATED tEREON SHALL. RUN ONLY TO TIE PERSON
FOR WHOM THE SURVEY 6 PREPARED, AM) ON HIS BEHALF TO
74 THE 'WU COMPANY,GOAINMENTAL. AGENCY AND LENDING ' c
INSTITUTION LISTED HEREON, AND 10 THE ASSIGNEES OF THE SCALE:
"s ' I ' DATE: -
LENDING INSTITUTION GUARANTEES ARE NOT TRANSFERABLE �A`
TO ADOfTTONAL INSTITUTIONS OR SUSSEOUETR OWNERS. SUFFOLK COUNTY TAX MAP 'Of O,Q
EASEMENTS AND/OR SUBSURFACE STRUCTURES' RECORDED OR jDp0 a1�00- DiOtsip12.0on SURVEYED BY A.Q.. t,SkK. REA
UNRECORDED ARC NOT GUARANTEED UNLESS PHYSICALLY DIST. SECT BLK. LOT LOTHAR K. REISS CO .,. •
Ss'
__ EVIDENT ON THE PREMISES Al THE TIME Of SURVEY. G'
A THE OFFSETS OR DIMENSIONS SHOWN MEA
EDN, FROM THE
PROPOSED HOUSE LOCATION 4 DIANE LANE ° ,�
PROPER Y LINES TO THE STtttAilIARES, ARE FOR SPECIFIC Q.
UPDATED EAST MORICHES, / �� J Q%°/
PURPOSE AND USE, THEREFONE THEY ARE NOT INTENDED LIC.* 49250 �'
a TO MONUMENT THE PROPERTY ONES OR TO GUIDE THEr�h ,�
r r-n r�l r1f' c r t,'r• •,,..,.,- ,--,