HomeMy WebLinkAboutChellon, Ralph �c��FFO(KCOG_=
JUDITH T. TERRY : ; Town Hall, 53095 Main Road
TOWN CLERK :
1=2
r=T, P.O. Box 1179
cls Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO •�� Fax (516) 765-1823
MARRIAGE OFFICER '='`^ .. ," Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER '_ 0'.
FREEDOM OF INFORMATION OFFICER -,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1124 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MARTIN & MARTIN BUILDERS
Address 1 : 121 WEST SUNRISE HIGHWAY
City St Zip LINDENHURST NY 11757
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICE. SCHD REF.# R10-94-0031
Name Of Owner CHELLON, RALPH F.
Mailing Address 1 OLD BARRINGTOWN ROAD
City St Zip HOLLOWVILLE NY 12530
Property Address 1 GREENWAY EAST
City St Zip ORIENT NY 11957
Tax Map No. section 15.00 block 1 lot 15.000
Cross Street PARKVIEW LANE
Building Permit Number Cross Reference:
Issue Date: 5/11/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
„, ��FFo�K�D�
JUDITH T. TERRY : L . Town Hall, 53095 Main Road
TOWN CLERK : o rZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS y Southold, New York 11971
O�
MARRIAGE OFFICER '. a '".4, Fax (516) 765 65-1
RECORDS MANAGEMENT OFFICER _'0 4111 �,1, Fax
(516) 765 1801
FREEDOM OF INFORMATION OFFICER = r�
OFFICE OF THE TOWN CLERK 4
TOWN OF SOUTHOLD
" 29 .94 r`.
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office TOWN ' 4 . .
DATED: April 29, 1994
Transmitted herewith is a copy of application No. 1163 for a Cesspool/
Septic Tank Construction Permit submitted by:
Martin & Martin Builders , Inc. for Ralph F. Cheljon
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
DISAPPROVE
Comments: 5. /D ,f ' ///471,/, /866” ,1/94
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t3/0- he-003/ .�
REciv p
NAY 1 1944 /"/
Tow Clef Iona*
Signat�ur:
Dated /
.r
` .
OFFICE OF THE TOWN CLERK cOFOLt'
Town of Southold A �.A . Application No. //C, 3
Judith T. Terry, Town Clerk 1 �G
Town Hall, 53095 Main Road >�_. Construction L-------
P.
/P. O. Box 1179 �.
O . ��� Alteration
Southold, New York 11971 *
Telephone 01 Nga0 '' 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 i/,2//91I
APPLICANT NAME: kAt7?-4., 9-Ytur V La
APPLICANT ADDRESS: /02/ ftI c ovizzó t/ -1
LCNl)enctidies,r, NY. //7c-)
SEPTIC CESSPOOL V
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
3 RSH I TIHLC{ 64cd iLi;utnlc — .)- - •
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Avg r etict.LaN
OWNER MAILING ADDRESS: Oa gAe1astrol ni 60,
f kti,oWvcA6, MI. /in()
OWNER PROPERTY ADDRESS: 6/165A/4)/V 6rd s j
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section CPS- Block / Lot /S-
CROSS
SCROSS STREET: �F}2K 1/Leid 1-M6
BUILDING PERMIT NUMBER CROSS REFERENCE:
ill
AM &
/
4
Sighat ' of Applicant
(Th jRECEIVED BY: (AfiA).4-`------
// To n Clerk's Office
DATE: // 7 yy
I -..,.,,,,,w••- - -
SUFFOLK CO.HEALTH DEPT.APPROVAL
.NE. �o. MAP OF PROP E2 T Y H.S. NO.
it I %/
-- 50' - _iu2VEYEP F:7)r2
(va:ar;-, r4.6 \3tl, INCMAR
(4.6 .
✓
AT
1 ORIENT
STATEMENT OF INTENT
• !26.51 �� ,6+1 TOWN OF SOUT I{;J[_0 N.Y. i THE WATER SUPPLY AND SEWAGE DISPOSAL
�^ 44 IO �rz ISEPTIC cr.)¢F�2) SYSTEMS FOR THIS RESIDENCE WILL
_./Q` I Os t CONFORM TO THE STANDARDS OF THE
0 WELL AREA-
r w U, I""�""� I SUFFOLK CO. DEPT. OF HEALTH SERVICES.
S1 _ 150.,,:f‘1%.0._
50 m (5)
v '' + I APPLICANT
w f—� WELL AREA- i i
a _
O � F.- SUFFOLK COUNTY DEPT. OF HEALTH
/ u ZI 1.2 I SERVICES - FOR APPROVAL FOR
W 35 lI1A� CONSTRUTI,O(l QM.Y
�7 f
\�P DATE. I+
�� -_ 1 H.S. REF. NO. 1 tom,c'!'_4---2.--c-;:-)c--3-_,
t7 1 �^
® � I APPROVED `` ,, �T 'r ,
(VACANT) e J_' — i w� I SUFFOLK CO.TAX MAP DESIGNATION:
�' c } ..-t 4=- O c I DIST. SECT. BLOCK PCL.
Q . (r yCS4' 1000 015 1 15
zr
J 2 - } Z OWNERS ADDRESS:
G/-R.` PROP. lL 2 •', C POOL AREA- i
GR1VC
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i MAQTI,.I AI r 1BUILDERS,
M 1\,
121 w.SUNRISE HIGItWAY
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I °-c 35 ��` SEPTIC' v (t) LINDENHV25T N Y 11757
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co > 5, +4 +9 �_ - DEED: L.N(A P.
s 3='11'50 w / 130.0 ••- •'`• � A2EA'22,185 5Q.FT.
G3=MGNIJS�1 NT TEST HOLE STAMP
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NOTES• x_ ,
I t' tZ E ACRES AT R1ENT /
y t.',,,
LQT NOS.REFS t TO MAP OF G E NAC 0 , I
�--- 1 AS SURVEYED MAR.7+I9_ o z��"q *.k
t I 9 Q, I 1-10. -- - - 2
FILED N THE SUFF. OO.CLE 1 5 OFFICE AS MAP NO 5Q- RODERICK VAN TUYL.P.C. �(
2.ELEVAT!ONS SHOWN tZEFTO MEAN SEA LEVEL. �r• I/'+-- i°- �Q
— WEU_+ ` ( I- , - LICENSED LAND SURVEYORS `�sE�Nog�P°tams `
C hOptS GREENPORT NEW YORK
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