HomeMy WebLinkAboutHorton, Debra (4) ,•%pF SOiii
ELIZABETH A.NEVILLE '`� Kol0 : Town Hall, 53095 Main Road
TOWN CLERK ANI , P.O. Box 1179
va Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; G Q ,�
MARRIAGE OFFICER �t Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER l�'C �/4\���� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER OUI�1,+ ,.�' southoldtown.northfork.net
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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. 3382 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DEBRA HORTON
Address 1: C/O CRAMER CONSULTING GROUP
City St Zip MILLER PLACE NY 11764
Descripton of Proposed Construction or Alterarion
-SINGLE FAMILY DWELLING 36' X 44', IRREGULAR
-FINAL APPROVAL REQUIRED FROM THE SUFFOLK COUNTY HEALTH DEPARTMENT
Name Of Owner DEBRA HORTON
Mailing Address 1 1465 PINE TREE ROAD
City St Zip CUTCHOGUE NY 11935
Property Address 1 3205 DUCK POND ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 83.00 block 1 lot 15.000
Cross Street VISTA PLACE
Building Permit Number Cross Reference:
Issue Date: 10/27/05 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �' � yOIO Town Hall, 53095 Main Road
TOWN CLERK l * , P.O. Box 1179
va �r Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ; G Q ,�
MARRIAGE OFFICER Az. r Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER �,� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `= CU(J %�
, ,0 , southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
ju OCT 2 4 2005 J TOWN OF SOUTHOLD
i L
TQ2:_� o tlroi T ucvniBuilding Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 21, 2005
Transmitted herewith is a copy of application No. 3531 for a Cesspool/Septic Tank Construction
Permit submitted by:
Debra Horton
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: -' �/ 400"-
Signature
g-4?V"-L- 'EX'S—
Dated
OFFICE OF THE TOWN CLERK ,'e'col oureOG.
TOWN OF SOUTHOLD iQ Application No. 11(3k
FT T7ABETH A.NEWT IF,TOWN CLERK V 4C-1
P.O.BOX 1179 y� Construction
SOUTHOLD,NEW YORK 11971
tiTS
1Alteration
Telephone `004, ���6', . $10.00 -Residential
(631) 765-1800 _"1. �,�" $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 33ga
Fee .$
DATE /O - OS
APPLICANT NAME: ))5(O G Afortelf
APPLICANT ADDRESS: lb erOr In I ' 4 fro
.P0 _r. -
SEPTIC y CESSPOOL
ESCRIPTIO OF PROPOSED CONSTRUCTION O ALTERA ION 3 J/vN-
- 31{ x tr-e U�4 .
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED C STRUCTIOI OR ALTERATION: UC PUVd / U\4?&/
OWNER OF PROPERTY: ra . ICS
OWNER MAILING ADDRESS: (sl1 &e.1t Ow 'o1 �c ( rOs
PO ;� 2 M r er -�1 Ke (06
OWNER PROPERTY ADDRESS• 0 I Ia./
ft- •
TELEPHONE NUMBER OF CONTACT PE ON:7k0 ( l
(-�(�i(�v `f76-6
TAX MAP NO. : Section _ CEJ Block I Lot / S
CROSS STREET: Pt( (°c
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature o' Applicant
RECEIVED BY: A1 W--'
Town C rk's Office Notary ,SateofNewYork
DATE: LUkaO , No.4994281
Qualified in Suffolk County
Commission Ex;-;723"' ' 4'
EXCEPT AS PER SECTION 7209-SUBDIWSION 2. ALL CERTIFICATIONS
SURVEY OF FROP'ERT Y HEREON ARE VALID FAR THIS MAP AND COPIES ?HEREOF ONLY F
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
AT CUTCHOG UE WHOSE STOW TORE APPEARS HEREON.
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N. Y.
1000-83-01-15
SCALE: 1-X'
JANUARY 14 2004 N
Nov. 19, 2004 tod ►lions)
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FFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
%%RMIT FOR.APPRO' '_d OF CONSTRUCTION FOR A
6INGLE FAMILY RESIDENCE ONLY 1 I
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FO• MAXIMUM OF ''{ BEDRv OMS a/ 12 \`�� \\' \\ \ . i ; f
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EXPIRES THREE YEARS FROM DATE OF APPROVAL / • I 1 • 'Z1... / / /
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YPICAL FULL CRIB # CROSS SECTION SEPTIC SYSTEM
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E TAS WALL ..
1tt_ L O T NUMBERS REFER TO "MAP OF VIS TA BLUFF" FILED
IN THE SUFFOLK COUNTY CLERK'S OFFICE s - •
7 \..:0,I, 15, 1968 AS FILE NO. 5060. PIE OF NE&"� co ANT.METS O4)
1 Ott Es g., ELE VA TIONS REFERENCED TO N.G. V.D. '9 ' c�
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'< '' i�,CONIC YORS, P.C.
AREA=22,498 So? FT (631) 765-5020 FAX (637) 765-1797
, P.O. BOX 909
1 1230 TRAVELER STREET
SOUTHOLD, N. Y. 11971 03-306
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