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JUDITH T.TERRY �/ y1�� Town Hall, 53095 Main Road
TOWN CLERK 1 0
y Z P.O. Box 1179
`" Southold, New York 11971
REGISTRAR OF VITAL STATISTICS k46. � Fax (516) 765-1823
MARRIAGE OFFICER �f O RECORDS MANAGEMENT OFFICER '- O! 4; 10. Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER iost
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1747 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SHAWN AND DAWN WILLIAMS
Address 1 : 405 SOUTH DRIVE
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. REF #R10-97-0144
(DEMOLITION OF EXISTING STRUCTURE)
Name Of Owner WILLIAMS, SHAWN AND DAWN
Mailing Address 1 405 SOUTH DRIVE
City St Zip MATTITUCK NY 11952
Property Address 1 405 SOUTH DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 11 lot 20.000
Cross Street BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 10/09/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
/ 747
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JUDITH T.TERRY �'_F 6 Town Hall, 53095 Main Road
TOWN CLERK % y
P.O. Box 1179
P�i Southold,New York 11971
REGISTRAR OF VITAL STATISTICS
� Fax(516) 765-1823
�
MARRIAGE OFFICER :y4f0 `a��i1� Telhone (516) 765-1800
RECORDS MANAGEMENT OFFICER ? `�► 1 P
FREEDOM OF INFORMATION OFFICER •••• pis"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 6, 1997
Transmitted herewith is a copy of application No. 1820 for a Cesspool/
Septic Tank Construction Permit submitted by:
Shawn and Dawn Williams •
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
OCT 8 1997 'gnature
v/i19
Southold Town Clerk Dated
()PI-Ic�I_ OI-' 1 HE IOWN CLERK ►►'Oct\\`fill,(-(
I own of Southold , �.,; �G�.
)�i(lill, I I . Ferry, Town Clerk „ .;r:i. ��i, Q1.:• .\ Application I•lu. j gvg d
k
I own Hall, 'i 10)5 M1�1)1 Road
; !1 .,I;f';t:' ..
• . Y
I'. O. (lox 1179 to ,1,c� +,1', ,I �. a Coiislr(i(:lluci. .._ ... ...
�� I Alteration
Sow hold, New York 1 I J71
''. . . r`Off(-' _...... .... -..... -.
Tele ��6� 44 $ rjr Residential
( 516) 765 - 1001
Non Residential
TOWN OI, SOIJ1 IIOL[)
SOUTIIOI-u WAS.1 EWA 11:R DISPOSAL DISTR IC]
,I'PI.ICA I ION
I(P1
(:ONS-I RU(: I ION u(• ALTERA 1.1011 I'LRMI I.
SI:I' I I(: I ANI< o( CESSPOOL
I'co( mil Ido,
DA I l
AI'I'I_I(;AN.1 NAME : Sc\----e4.91/4.)3Th ....c,__ ___,k - k j4-"i Oak cain_S
A11P1.1CAN I ADDRESS: O`c 3 ( ------ 0• 1( ,..v. /(9-3-2,..
. __....... . _ . ._. ..
• ••••
SEP 1-IC CESSPOOL
IESCRII' I' ION OF 1'ROI'OSL:1) CONST!MCI ION ( It AI.. 1-I:ItATION
.__ . - - \ ___ _,. - ' . .a--.(' ''k-
Loci\ I ION MAP: Must he at(ached hereto I,olore permit way he Issued.
I.00AI ION OF PROPOSED) CONSI. I(I-JC1- IOIl OR AI.TI RA 1" ION :
OWNER OF PROPERTY ER 1Y :
OWNER MA!LING ADDRESS: d— i ( ..\ --- 1`— ,
OWNER PROPERTY ADDRESS :
TELEPHONE NUMUER OF CONTACT PERSON : 8(::-
1 AX MAI' NO. : Scc tion f u Mock 1.. Lot — ? 0
CROSS STREET : l � \
ISIJII.I)IFJ(; PERMIT Nt1M13i:lt CROSS REFERENCE. :. cLauti4\. .
.. 1).AffLe,0_,,..,,. )
Signature 0 Applicant
RECEIVED BY :
1cp1 Clerk's O((ic.e__..
DATE : 6
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)LK COUNTY DEPARTMENT OP HEALTH SERVICES
Itti'1'FM APPROVAL OI '1WC1'1ON FOR A
S Gift MOLY 111111111SNCIS ONLY
O 1 N7 E 7 ' 2 Received
s,Itfo.County
FOR MAXIMUM OF if BEDROOMS SEP 15 1997
TIRES THREE YEARS PROM DATE OP APPROVALD c tOf Of Health
tewat NMemt.
Off
SURVEY OF
LOT D
MAP OF
SHOREACRES
FILE No. 41 FILED JANUARY 3, 1914
SITUATED AT
MATTITUCK
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK .
S.C. TAX No. 1000- 106- 11 -20
SCALE 1" =30'
JANUARY 24, 1996
AUGUST 29, 1997 PLOT PLAN
NOTES:
1. EXISTING ELEVATIONS SHOWN THUS: ARE REFERENCED TO AN ASSUMED DATUh
2. MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOUSE IS 1 ,000 GA
1 TANK; 8' LONG, 4'-3" WIDE, 6'-7" DEEP
3. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS 300 sq ft SIDE'
1 POOL; 12' DEEP, 8' dia.
-EXISTING
EXISTING CESSPOOL