HomeMy WebLinkAboutWilliams, Edward //_, __
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JUDITH T.TERRY ��� y� Town Hall, 53095 Main Road
TOWN CLERK • P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS Southold, New York 11971
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MARRIAGE OFFICER 4.y;* Fax (516) 765-1823
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RECORDS MANAGEMENT OFFICER .( `1►osd Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER -....„ .0
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1441 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDWARD E. WILLIAMS
Address 1 : 1300 MINNEHAHA BLVD.
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-96-0012
Name Of Owner WILLIAMS, EDWARD E. & ELLEN E.
Mailing Address 1 1300 MINNEHAHA BLVD
City St Zip SOUTHOLD NY 11971
Property Address 1 16315 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 23.00 block 1 lot 12.000
Cross Street MAIN ROAD & R.O.W.
Building Permit Number Cross Reference:
Issue Date: 2/22/96 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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• JUDITH T.TERRY ; o 'y1 % Town Hall, 53095 Main Road
TOWN CLERK ti Z $ P.O.Box 1179
Ply III Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1 Fax(516)765-1823
MARRIAGE OFFICER y�
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RECORDS MANAGEMENT OFFICER 491 ills 4.„11$ Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER •.~.,, ii"
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OFFICE OF THE TOWN CLERK i
TOWN OF SOUTHOLD ILBI6iggr'i 1
TO: Southold Town Building Department BLDG.DEPT.
OW__ N OF SOUTHOI D
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 16, 1996
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Transmitted herewith is a copy of application No. for a Cesspool/
Septic Tank Construction Permit submitted by:
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: - Age (-5-a' � ,► / % 141/(2--7‘-00/Z-
/
Si! ature IIIIr
4, -
Dated
OFFICE OF THE TOWN CLERK �,,o�, "
Town of Southold ��'' � f01.1(1
Judith T. Terry, Town Clerk �`� �� .� ��/ Application No././
Town Hall, 53095 Main Road �� 1 �s. ��: Construction
P. 0. Box 1179 � � � ;
Southold, New York 11971 tc:=3t� ., Alteration
•
Telephone "�,0 tc,�•� $10.00 - Residential
•
(516) 765-1801 1 $25.00 - Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE - ' � (-1(2
APPLICANT NAME: Edw. e awl.; d►til S
APPLICANT ADDRESS: / 30e, lhfhilikifitb BIvD
• S o vies/.1, w•y • 119 7/
SEPTIC / CESSPOOLS
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
FtI7 I)fcu c(w£1/141
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PRVOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : auEAi k
OWNER MAILING ADDRESS: 13 00 1, iptich .0 1,)V,m
SQt.4& td) IX'- 1f )f
OWNER PROPERTY ADDRESS: fb 315- ,y1,jM TZ.-(09
Sr 11104, m0 46137
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TELEPHONE NUMBER OF CONTACT PERSON :
TAX MAP NO. : Section .023 Block / Lot /
CROSS STREET: 14/14 ( p(,v
BUILDING PERMIT NUMBER CROSS REFERENCE :
EauG.
Signature of Applicant
RECEIVED BY :
Town Clerk's Office
DATE:
1 H.S. NO. -
J.„E -3 , ,
'j,"',/N.55-17'2 C1tE o
wet! _ -
1,7-re. ft.ray .
7;�./ i I `` STATEMENT OF INT NT
THE WATER SUPPLY AND SEWAGE DISPOSAL
i - - �.� ,
,-h :esspooes SYSTEMS FOR THIS • RESIDENCE WILL...?
/
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CONFORM TO THE STANDARDS OF THE
/,
SUFFOLK CO. DEPT. OF HEALTH SERVICES.
MAP OF P12OPE2TY _ �'',
:3t,I2VEY 7 FCIL2 i -1�7 ( ` /1,167.^-.-�-L' f 21 r— __ __1 // •r (s}
DI.G _i Y Y�L�LIi`�M.�7 ! a '�� t op•iroc's0 "c:,sQ �,J APPLICANT
�_ L 6o, r \D �,.,....„,
r � yll..` J `/ SUFFOLK COUNTY DEPT. OF HEALTH'
%l T" 1...,;:0*
` �J SERVICES — FOR APPROVAL • OF
EAST MAIZ ION '�-�, , �+- ( r
,� ,// 94L� CONSTRUCTION ONLY
Tower OF �cxm-Kx.D,NLY. ,4,-,, ;-tet drs''bd.! p.'�'e V DATE:
b.,‘rc or 'Thi )� (. 3 a /
_,,wen Is/ H.S. REF. NO..
,O l' 8'A x —_ISO i'; APPROVED:
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICESs/t`-_, -5 S l J i
a o- e ) {
! o " j _ — T L` / SUFFOLK CO.TAX MAP DESIGNATION:,
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A o —— /� ! if % '
• SINGLE FAMILY RESIDENCE ONLY pA�eci. !----'1` t�I �/ i DIST.It;�00,SECT.023 BLOCK!,` PC.L.i2J
�,+, 13P199 NS r N coo-/�-�0,� o
c► OWNERS ADDRESS:
Q"f-:.`y '' ✓.` '1 'J ?�._.. 153 i / ', I j/ \� / l/' // t SIV iLr...fi+K a+e7 -
• FOR MAXDIUM OF, BEDROOMS . . '
tT�IRES THREE YEARS FROM DATE OF APPROVAL / `°' ` / 5 TNC?LO,N.R; 11971. .
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S / N , f 'Tct., OCit) ',
- v `N; _� t` DEED: L.722i P.2O7 � .
Area =54,887 �tf�. °� c;?CE NOTE !V• ` ' / h%/ t1j n f � ¢3.� , ..�, 9 E5� , T��4 `� L��?�
C ►�ca! r) Sani�ar system i o ; ' A.
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Q t►?Ottutttll f f placed under i 7 c r{�,I I V"' j' ! sae on�zaa of the New York stats
f_ec babe law.
�A� I�a. f ry1�,,• �/_�!j Cclesotthis surveymap not bearfng ,.
e, / a 1 : �j t' Me land surveyors Inked seat or._ '
` / , , �' ? Amended-Feb.I, (996 i I embossed seal shall not w considered
,� / } /•i .9 Feb. 7,199Eosanto he aid buacooy. . ,-
. �� "�`(� C�75 tn_ `,j/`/' , Y �, i• Gareanteea wanted hereon shall nr
�t ,`r� ,p / `m
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prepared.and on his behalf to the
,,'�, • r /' � tela company.govemmentai agency end
G HCl v. 5 [ i A
/ j ruing insl°ut.on listed he eon end .y
� i /� 11' _ _/ 4r t the:;stgnees of the lending lug- r"
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not transferable
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�° 132.13/
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t l.�yrC� ! 13
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