HomeMy WebLinkAboutTuthill, Donald O
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i B Town Hall, 53095 Main Road
y0 Off. P.O. Box 1179
1411 ►1 Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1709 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JEFFREY & HEATHER WORTHINGTON
Address 1 : 45 EAST ARGONNE ROAD
City St Zip HAMPTON BAYS NY 11946
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 #R10-97-0091
Name Of Owner TUTHILL, DONALD (SELLER)
Mailing Address 1 3150 BOISSEAU AVENUE
City St Zip SOUTHOLD NY 11971
Property Address 1 1025 LONG CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 55.00 block 3 lot 28.000
Cross Street LAUREL AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/31/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY t _ 'l Town Hall, 53095 Main Road
TOWN CLERK ; N P.O. Box 1179
n1 Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
V6 �� Fax (516) 765-1823
MARRIAGE OFFICER �y ��
RECORDS MANAGEMENT OFFICER � ,� 4, 0„.0 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: July 30, 1997
Transmitted herewith is a copy of application No. 1778 for a Cesspool/
Septic Tank Construction Permit submitted by:
Jeffery & Heather Worthington
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.
e"4-‘(-4
Linda J. Cooper
* * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE V
DISAPPROVE
Comments: ,te.eeG I/eet_ t vC�
'gnat 4
1( 3c197
Date
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` 0FHUL OF l}|E 10YVN CLERK
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]'x|i|)` l Ferry, Town Clerk Application No. / _/_/'�y
T"wo i|aU' 53095 Main Road Construction c------
P. O. Box 11790 . ------ '
Southold, Nev, York 11971 Alteration
Telephone Residential � ^'
(516) 765lVOl `�c/rn/*'�
Non Residential
'-
TOYVN OF S0U[|0LD
SOUT||OLU WASTEWATER DISPOSAL DISTRICT
A|1`|'|[NION
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' (or
C0NSTRU[[ |ON or Al. BRAT|0N PERMIT
SEPT IC TANK or CESSPOOL
Pei mit No.... . -
Fee $
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A|`|1 !CANT NAk4E:
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APPLICANT AtmnEss:/\ODRESS: -
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S[Pl-|C CESSPOOL °^
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NES(]l|PTION 01: PROPOSED ( }N8 |(U(] 10N OR A LIE RAT ION
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LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONS T!MGT ION OR ALT ERATION:
OWNER OF PROPER l'Y : L[) ��~
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0YYNER MAILING ADDRESS: 3'J-0 /fo/��-C4t) -ikE--,
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OWNER PROPERTY ADDRESS : /Oa .5- / okx- {°.,€���C �).
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lELEP||UNE NUMBER ()I: [0Nl�/\ClI pE|�S (� �/�� � �~������f'«����
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|AX MAP NO. Section Block /»( -- -
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CROSS STREET : I- '4'� �":" /+1'6-
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BUILDING PERMITNUK48E|< CROSS REFERENCE : „, ^
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j,k,CrAtddc.{:t W10-74i qr/IL
Signature of App lit� -----
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RECEIVED BY
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To Cl .wk's Office -' -
DATE : / / ^/ i/
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NOTES:
1 . TEST HOLE DATA REFERENCED FROM TEST HOLE No. 2 AS SHWA
2. EXISTING ELEVATIONS SHOWN THUS:Ms ARE REFERENCED TO N.
3. MINIMUM SEPTIC TANK CAPACITIES FOR A 1 TO 4 BEDROOM HOl
1 TANK; 8' LONG, 4'-3" WIDE, 6'-7' DEEP
4. MINIMUM LEACHING SYSTEM FOR A 1 TO 4 BEDROOM HOUSE IS
2 POOLS; 6' DEEP, 8' dia.
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Tc„ .>�.:”' . - • CERTIFIVD TO:
Brett+
atm. FIDELITY NATIONAL TITLE INSURANCE COMPANY
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STG- ASSOCIATES, Inc.
JEFFREY -WORTHINGTON
j HEATHER HILL WORTHINGTON
J
UNATHORIZED ALTERATION oR ADOr
' TO THIS SURVEY IS,A VIOLKRON 0
4,LrFOLKCOUN-1YDEPARTMENTOFHEALTHSERVICES T EDUCATION00OF,THE'NEVI YORK
_ _ PERMIT FOR APPROVAL OF COT TRUC 1ON 1POR A cowES OF THIS SURVEY MOP NOT
THE LAND SURVEYOR'S INKED SEAT
LE AMILY RESIDENCE ONLY EMBOSSED SEAL SHALL NOT.BE C
/ TO BE A.VALID TRUE COPY,
DATE ( `j •__,..,... +trore iitme =Hp ori
DWELLINGONLY TO THE PEON FOR'WHOI4
(USES PUBLIC `MATER) �r ��.� IS.PREflARED, WO.ON NIS
APPROVED , pN�` `
TO THE OF THE tool
FOR MAXIMUM OF BEDROOMS TURON. CERTIFICATIONS AREa+ T ''
EXPIRES THREE YEARS FROM DATE OF APPROVAL .
THE EXISTENCE OF RICEASSO
AND/
MOT SHOWN ARE HOTC(1
PREPARED IN ACCORDANCE WITH THE MINIMUM ,
A HEROS FOR TITLE SURAS ESTHED Joseph., '
BY THE 41.A,1.3. AND APPROVED AND ADOPTED
FOR SUCH USE BY THE NEW YORK STATE LAND
TELE v.• TION, t.r.
ILED MAP. p LAND S 1 Land 'Survey
929 DATUM. 4r40 .µA.tifii,
G of A,000 GALLONS. a 41 . ;3 Title Surveys — Subdiviaio►ts .— Site Pion 'Cod
ft SIDEWALL AREA. * 1it ' ii * � PHONE (518)727-2090 Fax-+
`'' ` i -
q No Arppg. •
OFFJCtt LOCATED AT µi
I • N.Y.S. Lic. No. 49688 One Union S aOrs • #
- li;_ WE' Apuebork Now_York 11931; ' . - RhAtirhs