HomeMy WebLinkAboutGoldsmith-Agosta, Cynthia (2) SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 3314 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : CYNTHIA GOLDSMITH-AGUSTA
Address 1: PO BOX 747
City St Zip EAST MARION NY 11939
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 #R10-05-0025
Name Of Owner GOLDSMITH-AGUSTA, CYNTHIA
Mailing Address 1 PO BOX 747
City St Zip EAST MARION NY 11939
Property Address 1 80 GUS DRIVE
City St Zip EAST MARION NY 11939
Tax Map No. section 38.00 block 7 lot 10.012
Cross Street SHIPYARD LANE
Building Permit Number Cross Reference:
:issue Date: 5/18/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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,,%`OF soji7 _ 3 I i(
ELIZABETH A. NEVILLE 0 AC, Town Hall, 53095 Main Road
TOWN CLERK %% 4 * P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �Q rFax (631) 765-6145
RECORDS MANAGEMENT,OFFICER ql� .0 Telephone (631) 765-1800
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FREEDOI F INFORMI •FFICER = COUtfril\‘ °."1 southoldtown.northfork.net
i i•;° " -
``,l►.4 APR 5 \OFFICE OF THE TOWN CLERK
1 TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 15, 2005
Transmitted herewith is a copy of application No. 3459 for a Cesspool/Septic Tank Construction
Permit submitted by:
Cynthia Goldsmith-Agosta
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 formbelow and return it to me.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
•
Comments:
Signature
1
/' ) oZoos—
Dated
•
%OFF04
ELIZABETH A.NEVILLE - i474VTown Hall, 53095 Main Road
TOWN CLERK ' d 1 P.O.Box 1179
REGISTRAR,OF VITAL STATISTICS ‘ j* �� Southold, New York 11971
MARRIAGE OFFICER Fax'�i1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ��1, 0�i� Telephone(631) 765-1800
FREEDOM OF INFORMATION OFFICER =70'� ��i',." southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT "
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 /or Non-Residential @$25 Application No. 3 t-{cct
,, J Permit No.
Applicant Name 0A/11,44Aln(L. (d$rvt l e'k" A wos-\-- --
Applicant
Mailing Address 15 bX- 4'
Septic Tank or Cesspool?(--St MarIGYI AH! 0 9 39k) -e).,6 Brief Description of Proposed Construction or Alteration ha-L,tS t -
Location of Proposed Construction/Alteration: ,, /�
Owner of Property: C- . (u Idowo. - A' 5+-c.i .-----
Owner Mailing Address:)d 7 q
-fa - MO-0( -) fig ?)Q
Owner Property Address: D 61..A.sS alkYle T)y 1 V`e
-i- Ni ariin ) / ict 39
Name and phone number of contact person e rd / 60/dSni i--A-A-905*-- ---
Tax Map No:/COO Section 'elk, ' NBiock F;b) Lot / 0' 12,
Cross Street 5ipqarci /-0i Y?
NOTE: LOCATION MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES S "VEY WITH MALT: DEPARTMENT • ' 'ROVAL
,./1111.x' .:�L/j_..� 4 14 os
(A. '�� ---o Applicant i ate
Received by: . 0
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SURVEY OF LOT 24 .. 0
MAP OF SUMMIT ESTATES, SEGTION 3 N
FILED MAY 21, 2002, FILE No. I0'76q �a�
SITUATE: EAST MARION 4° X61, w E
TOM: 50 4111 OP
SUFFOLK • �.:4441) r�EPART � =" 2 O
A.>w?'rI SERVICES �ti\o� a
SURVEYED 12-2Q-2014 PE POR APPROVAL- OFCOMMIX-QCT ? „ c �� ,y
SUFFOLK COUNTY T• # f`rd.E P�!'�.��''SI�F�l�'�'E�01YLY' Y,��.�P�, ��� OO `,�.•�
1000 - 38 - 7 - 10.12 DATE 05 0 c, ,s IF •
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' '._F.NO,R��--0- ��a2 i QJ �°
Certified to:
APPROVED
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iiii �J� 023 >., �(�` �, ebbe.
S
IMUM OF 0`` - eer,�� cl- G
Cynthia EXPIRES Goldsmith-- :,: EED
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THREE YEARS FROM DATE OF APPROVAL �• ��
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and on and 1;to g"I tltN lon listed person For Delors the survey b Pr.""
ELEVA,�IONS REF�� FFOLK COUNTY TOPO MAPS a�.
��� time ar:w�tra,.fa-awe�adwmonal ustrrotnm
ASTIQRcl ACRES JOHN C. EHLERS LAND SURVEYOR
GRAPHIC SGA'L'~. , �'5' Z e 1"= 30' a°' 6 EAST EAIN STREN.Y. ET N.Y.S.LIC.NO.50202
MIN Ell Ell 111111•11111111111•11111111 369-8288 Fax 369-8287 REF.-\\dip server\d\PROS\04-349.pro