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JUDITH T. TERRY : Town Hall, 53095 Main Road
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TOWN CLERK O T ; P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS .' Southold, New York 11971
MARRIAGE OFFICER 0 O. Fax (516) 765-1823
_' � �� '.' Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 982 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PATRICK E. CALLAHAN
Address 1 : P. O. BOX 663
City St Zip NEW SUFFOLK NY 11956
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner CALLAHAN, PATRICK AND ARLENE
Mailing Address 1 P. O. BOX 663
City St Zip NEW SUFFOLK NY 11956
Property Address 1 DEEP HOLE ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 6.002
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/23/93 Judith T. Terry
Southold Town Clerk
'TOWN SEAL)
JUDITH T. TERRY ; Z •
Town Hall, 53095 Main Road
TOWN CLERK •
T • P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS tfl
Southold, New York 11971
•� Fax (516) 765-1823
MARRIAGE OFFICER � � O O� •
/iil �1D•
Telephone (516) 765-1801
APRI 6 IW3 OFFICE OF THE TOWN CLERK
11" TOWN OF SOUTHOLD
I3tr
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 15, 1993
Transmitted herewith is a copy of application No. 1008 for a Cesspool/
Septic Tank Construction Permit submitted by:
Patrick E. Callahan .
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 J(
DISAPPROVE
Comments: Cry..e _ C cL
4, � o`�k
Q.),.), v.a-Lu.O (�. .ck.QID,
Signaturei
Dated
1
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{ ` ,irr L•ICzj�
OFFICE OF THE TOWN CLERK c�rF0t„ .
Town of Southold Nij.: 1: .'
c.
Judith T. Terry, Town Clerk r'•'`` Application /G 0 r
,.r �;; No.
Town Han, 53095 Main Road c i.i, . L.---75 =` �
P. O. Box 1179 �' i1:`• 17,,v,„. _ Construction J
Southold, New York 11971 (2:‘ 4 21. -.c.' Alteration
Telephone
'ell xii ly�1i4 Residential ___
(516) 765- 1801 . �,�
Non-Residential
•
• TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
. for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
•
Fee .$
DATE
APPLICANT NAME: ra71,-ic 4 E. C e/%`i0H
APPLICANT ADDRESS: Po /3o x 6 3 lie wj'ci-!.o/4
. y.y. J/96-6
SEPTIC V CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
CO',5 Pt'C 7to4 a ?P'ovostd so/tic 5-y7s/.-7
7Io .S0.-s.v-c' "--,e, O* e . 6- ///- Aae,se
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION! OF PROPOSED CONSTRUCTION. OR ALTERATION:
• OWNER OF PROPERTY: ,t•14 ,c / //
• �/c4t �2l�41o •
• OWNER MAILING ADDRESS: 7e) to X/ l
OWNER PROPERTY ADDRESS: 2 ve , %ede• £ec
TELEPHONE NUMBER OF CONTACT, PERSON: 3 ^ S��fo 8
TAX MAP NO. : Section // Block
/ Lot � ,
CROSS STREET: //4.41 .rSe-,-(1:, /`, A.->e =0041:1/0 .
th S�
BUILDING PERMIT NUMBER CROSS REFERENCE:..
' Zife3, 4:/-7.,e.X.
Signature of Applicant
RECEIVED BY: . btl/a/L—__L-.
T 1.;Clerk's Office
DATE: 4L ,��� 3
, The locations of wells and cesspools shown hereon ore from field
'observations and or from data obtained from others.
N c H. S. REF. NO. 87 - -SO /31
C
SUFFOLK
AVE.
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N. 79 '00 1,1, 112.09 / 6/` DEED if
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MARY 87 N
The water supply and sewage 'disposal \ D. LE pE. 0
systems for this residence will conform ce„,e/ . ER
to the standards of The Suffolk County '�y
Department of Health Services.
r
welt •
1
SURVEY OF PROPERTY
AT MATTITUCK
•TOWN OF SOUTHOLD r_ ,., :.,.
fcsf 6o„,7y SUFFOLK COUNTY, N. Y4i.'Lo:r- '41""c'ql
1000 - 115 - 17 - 6.2
/.so;( . APR 19 1991
SCALE In=
40
86 S.C.b :.r
3.5 �1!� q At `'
Approved in Ac��c►rt�an, 6199t IC 2+ r
HEALTH SERVICES ..
„ac delemthtatlnd dated : , , :d in accordance with the minimum
standards
standards for title surveys as established
'I- -- - 9waler by the L.I.A.L.S and approved and adopted
end AREA z- 11 410 SQ. FT. for such urs by The New York Stale Land
" s'' ` Title Assoclation.
/7• • TO DtEO L!N E 5
TlFIED TO SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FANO lC , INC.
�4 N,L. ME?. FOR APPROVAL OF CONSTRUCTION ONLY
o 0�` c F 4PR 2 211 ,1 _ 1
' ' /�, p DA FL S.REF.NO�e
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.'iillriii �i'Mffr��g�i
:: :
. . N0. 49618 ���1�._I___�lm . S, P. C. APPROVED
5I '--4'..0*-
ELEVATIONS ARE REFERE. a1 TO N.6 .D.
P. O.
N. ELEVATIONS
MAIN RD,
; ',i . SOUTHOLD,N. Y. 11971 „oraposeol. hsc cJeptic, 4y44''1 4//9/9/