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JUDITH T. TERRY ; 1► Town Hall, 53095 Main Road
TOWN CLERK ` O T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS =cfs
�� Southold, New York 11971
MARRIAGE OFFICER V , Fax (516) 765-1823
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�1%, •� Fax
(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. 975 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PETER DENICOLA
Address 1 : 15 MIDLAND BLVD.
City St Zip LAKE RONKONKOMA NY 11779
Descripton of Proposed Construction or Alteration
CESSPOOL SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 3/15/93.
Name Of Owner CHARDONNAY ASSOCIATES
Mailing Address 1 901 NESCONSET HWY.
City St Zip NESCONSET NY 11787
Property Address 1 CHABLIS PATH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 51 .00 block 3 lot 3.007
Cross Street SOUNDVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 4/15/93 Judith T. Terry
Southold Town Clerk
!TOWN SEAL 1
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JUDITH T. TERRY L : Town Hall, 53095 Main Road
TOWN CLERK �O T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS %‘`04.4b.
_ Southold, New York 11971
MARRIAGE OFFICER O
y •� Fax (516) 765-1823
0� •
'II�,� �1� ��� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 7, 1993
Transmitted herewith is a copy of application No. 1002 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter Denicola a/c Chardonnay Associates
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 V
DISAPPROVE
Comments: 047_•1 matte, a,,, aar—w.c �--
C4ira-4.4.11. knit laya . W11.04.1.R_
3IICl°I
\C:CJIM. Or-E cto-cL,
Signature
\ -1\c‘%
Dated
. OFFICE OF THE TOWN CLERK c0FOi,e
Town of Southold D�,.:K COG
Judith T. Terry, Town Clerk r" ` Application No. /e) c
Town Hall, 53095Main Road o �:
Construction v'
P. 0. Box 1179 (1-1 ` t
Southold, New York 11971 • c.A• Alteration
•
Telephone "1 4 1%," Residential (�--
(516) 765-1801 11 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$
DATE Ac) It_ , I ((1
APPLICANT NAME: Re2 e 'J
cote,
APPLICANT ADDRESS: jS YY\'v "bke. o o
C ICP poktov.(Cop ..i. 114 vI , LTP9
SEPTIC ,O CESSPOOL✓
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
9 IN.a ' ec ,tacn'4aQ :.s 64' SCCM.CrC�^�.Z-
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: C 1.a4,1 .t C‘Lti GQSSOC ,cS
•
OWNER MAILING ADDRESS: 901 S(PSC"-Ce- 44LA-911
(`l'eSe..0 ?� 11.4. 1 1.7
OWNER PROPERTY ADDRESS: - w e figijs PAS
S ourXoc-hs
TELEPHONE NUMBER OF CONTACT PERSON: `73`) --`f 1 1
TAX MAP NO. : Section ( 146) Block CO.�,O0 ) Lot 003.007
CROSS STREET: Fc,v ,f),_
BUILDING PERMIT NUMBER CROSS REFERENCE:-.
Signature of Applicant
•
•
RECEIVED B Y: . (///a4('1----;
or Clerk's Office
DATE: 1/ / ( •
• 00. m/o t
SO' CHARDONNAY WOODS II SOUTHOLD •
.�Q��
E Filed Sep/ember 28, 1989 os Mop No. 8822
54.Bj. Zs • I •
3 PARCEL ZGIVED • i.:90- RESIDENCE
AREA OF PLOT i/000c.) f/— S.P.
PRO°. 1st FLWR r 01154. S.F, ,
PROP, 2nd FLLVR — S,F,
�O (n PROP. GARAGENT .,500, S.P.
*60 S.F.
N ASSUMED DATUM.
0
0CA TI/CRC ARC NC RS
O 4
u. THERE ARE NO WELLS WITHIN 100
FEET OF THIS PARCEL.
PI
• NAME ue,A,/i c 0 i .
ADDRESS
AREA = 40,000f S.F. or 0.9/8 Acres
IS M ,1 LA td ,/3
CITY LE.`% 'p i1C--0 b J Jc • Unauthorized alteration or addition to a survey map bearing a Professional Land
L,' 1� eV / U/S1/7Surveyor's Seal is a violation of Section 7209•Sub-Section 2,of the New York State
Ly PHONE (' SIM.-. — 3 3 Education Law.
PE YA7ER SUPPLY AND SEWAGE DISPOSAL Guarantees or certifications indicated hereon signify that this survey was prepared in
° accordance with the existing'Code of Practice"for Land Surveys adopted by the
is? SYS7D S FOP THIS RESIDENCE WILL COMMON "New York State Association of Professional Land Surveyors".Said guarantees or
N ro m'( STANDARDS AND SPE IFICA riC is or certifications shall run only to the person for whom the survey is prepared,and on his
F1 • K-cOUNTY DEPAR NT Or hc4LTH behalf,to the title company,governmental agency,and lending institution listed
Rilii I i. hereon and the assignees of the lending institution.Guarantees or certifications are
/ •O not transferable to additional institutions or subsequent owners.
GS b'/c ,--
.•-•
�APPLIefwr'S S)GNAlLlPf' •
Copies from the"ORIGINAL'of this survey map not marked with an'ORIGINAL"of
y`, .. the Lend Surveyor's RED INKED'seal or"EMBOSSED"seal shall not be considered
f eP'• i s.ITI'1-14,
1 r to be a valid true copy.
\<'' r ail it
SUFFOLK COUNTY DEPT. OF HEAL TH SERVICES
• raR AOPROVAL OF CONSTRUCTION Q'VL Y •
¢ DAT£t l ? N.S. RCP. NO.r f,• :1 ,'G
APPROVED?
_ PAIS%
, LOT 8) C ��
Cv x wl N q3
w �Y 19
a /
N SINGLE FAMILY DWELLNG ONLY ��� n OF
c� o?4•a,t . EXPIRES THREE YEDRS FROM PATE OF APPROVAL SO OE4� ,105
?�a`N 0 = 7676 O H�p\tH$4
e , - 50.00' O
" °kV , _ 66.7/' I
•
SS, `q R t Qi `�o a • •
SS' yy.C(A 111 COUNTY TAX MAP NO.: 1000-051.00 03.00-003.007
' 4 Q / A " `
A• 44 50•SETBACK UAE l - CERTIFIED TO:
4 . CHABLIS �`
S. 1.3°48'30" W. 1/5523' -4 PATH01 - SURVEY OF LAND AT o
NORTH SOUTHOLD
TOWN Of
(LoT 6) 11 SOUTHOL,p
SUFFOLK COUNTY NEW YO
rif 755.16' I hereby certify that this map was made BY EA.B -
R.21200• Edward A. Bullock, Jr.
L,lat. from an actual survey completed by me on Prolessiona end SufY@X4-/8 Engineer
i s� r9-d8 LL 9' DRAWN: A.G.
fk. (�e+lwate Q jv CG- r. Por es .n• SCALE.: 1"— 40'
O. _ N.Y.S.P.L.S. No. 49214 Hpw Yolk 11770 .
1N.Y.S.P.E.No. 63675 510473.63 FILE NO.: 1000-51-3-3,7
'KASSAII SUFFOLK BLUEPRINTING
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