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HomeMy WebLinkAboutClark, Roger JUDITH T. TERRY t`► Town Hall, 53095 Main Road TOWN CLERK c=9 T P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER _0 %)ir���, Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER :�'�1 + ��+Pe�� Fax (516) 765-1801 FREEDOM OF INFORMATION OFFICER ��i0�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1073 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : LYNCH HOMES, INC. Address 1 : (EI LEEN Z IMMERMAN) City St Zip SOUTHAMPTON NY 11968 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 SERVICES. SCHD REF. #93-SO-66. Name Of Owner CLARK, ROGER AND COLLEEN Mailing Address 1 P. O. BOX 279 City St Zip GREENPORT NY 11944 Property Address 1 TUTHILL ROAD EXTENSION (LOT 47) City St Zip SOUTHOLD NY 11971 Tax Map No. section 55.00 block 6 lot 15.053 Cross Street BOISSEAU AVENUE Building Permit Number Cross Reference: Issue Date: 12/10/93 Judith T. Terry Southold Town Clerk _LTOWN SEAL_ ) D7:) ,,,,o��FFo�k�oo l JUDITH T. TERRY z yZ Town Mall, 53095 Main Road TOWN CLERK z p ►'T • P.O. Box 1 179 REGISTRAR OF VITAL STATISTICS �` Southold, New York 1197 I MARRIAGE OFFICER0, Off(' '� Fax (516) 765-1823 ,`jj� 1� '� Telephone (516) 765-1801 00 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: December 8, 1993 Transmitted herewith is a copy of application No. 1107 for a Cesspool/ Septic Tank Construction Permit submitted by: Lynch Homes, Inc. for Roger and Colleen Clark . 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. ` �"'�. r— Thank you. 8 Y �c r TOVyW pF SUi1iI;(i . Linda J. Cooper I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE /J� Comments: 724, �� �'h) SCr7 L 4, 4n 73-Sc- 6 6 .% Signature/0 Date / Dated OFFICE OF THE TOWN CLERK 1ra ,,i% C' Town of Southold :J" s'' . O Application No. //0 7 Judith T. Terry, Town Clerk "t:-:'741.,. "-;,,� � Town Hall, 53095 Main Road c -- '� Construction P. O. Box 1179 O. .cA ? '. Alteration Southold, New York 11971 �- Telephone Ol r t 0 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 /c2 — 13 APPLICANT NAME: /LEE A.J z/A-r ti-1 E7e m g-iv, <-ViJ C-H r ►-n t—s,ZAJ4_ APPLICANT ADDRESS: 3.2 / e 0 .c Nr/ RI) 35 4 svo-n-iP-rnPTotil N y I /9 (pg SEPTIC X CESSPOOL}( DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION -/- N 5 T/4 c-L- ,Nl E tJ SEPT/G j, AJ,C / J /J Q iU E e G s S pod c- 4 S Pe-x2 5 u F"Ft) < Cv U nJ 7"`r. ff e-/4Z-7-rt 6'E72 I//C c--5 ---/-6 SERVic 6 NEW CombTRUC.T/vim.) ,51 &J4Lc FAn, lLq Dw61...cr/nli LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: 6-OGEY2. 7 Co LLE Gt.-)4&}< OWNER MAILING ADDRESS: Pc /? / 0275 G, 2EL---n_1 Po 1e-7- I ,U y 1 /5 4 c/ OWNER PROPERTY ADDRESS: LOT 44 -1 -TO 7/I/ I-6- AD E.lre/v /0AI Soo oc_ p TELEPHONE NUMBER OF CONTACT PERSON: LyNG#tfthmE5,2-/lJG 2S3-0o05 TAX MAP NO. : Section 5-6- Block Co Lot / .5-, 5-3 CROSS STREET: SO--e-c;;<;;;02-,2- / • BUILDING PERMIT NUMBER CROSS REFERENCE:.. cc2/- k_____________ Signature of Applicant RECEIVED BY: Ce..) Town Clerk's Office DATE: / �� (73 :y-• •• -•.1-....-7A'ff H. S. N O. . . '1-,-;•`'-,.., -'-'-',t.,. .-,-%-...-,- -„,,,9„-,,,---:•,',..-,, -,--:- . „, ., .,.,,,,.. , . • , . - - . . .,.. . , . . . , . . . ...,, 1 . , . IINICILE IFAIALY DVAILLNGIONL't : . , . . i3ippiEs 111'1E'Ifiiii$FAO"DATE OF APPACP/M. • . . , .. ...., , .• . . . . .. ' . 04.._ , 4,,.•.‘ A. -r.....---•-----------1 4 ... 5 -----'1,. . • . ., , I STATEMENT OF INTENT 1 ' • ...- ' t'4' 1 ' I I '' cc' 8 • \ \ \ . • i . STYHSETWEMASTERFSOURPPLTYHAISND RESIDENCE EISPOWSIALLL I . . • i ; tp• : k 1 (Th - ..---; --- .,--- ----- CONFORM TO THE ..... L-_-\ . . /\ : fr , •-ir 1 10 Si kJ --.". ',., .4 c.,P4-2- r- I, k,:p#313tic wATerz) I ; 44.--- ; k) ) ' • 4 ,,,,,,I,Ca- Ii......,..................„,,_\ • 1." 2 . -„, ) Q 19 • • . SUFFOLK(5) CO. DEPT. OF HEALTH SER VICES. /\ ' ' APPLICANT .- 9.. ' - • • ' .. ' -- , . ,, I - '' ' A i —- ,•:-:A:.,- .:4..,::', i - ,,,,i4Pw ,- ' _ , , , . .- pig,"•rr) - , , -_ , < S-- - '' ' , Isi 55 56 2 E _ ..4,,,,,.., . . , , . .,.. SUFFOLK COUNTY DEPTSERVICES - FOR .p. FrtOOFV4-4,HLEAFLoT}41t,k:',:i ,,, ,4 !98,96 Ari,,,,•,a,• cy,til € " . .. , ,., , • .. r..'..,.,' -- doNsTR. ucTIO, N,ONLY li AuG 1 7 . .,Fatz-ref-WOrt.Alty N:liftt..t-.,,........,.,' , ,,,. , ,; . '' ,LA, ' ', ' . 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PCL,,, • -- - ' . - -''', fs.60 -''' I 'I ' '' 1 1000 55 ' ' .•(:)• -', ',, • ‘•!': , . - .. . „ . ,... . ; . - - ••_ • ••• ':„. k - 0- * . : - '' ' - OWNERS ADDRESS! . =•• -, ,• 3 I _ 4 , • \14".1- -..a . . 0 '1/4i; - .• / _ • _____I . . „ ' - - ' i - . :.• t-.. . )., . -.1t-r ,-'. ,• _ ------ ' - - •-•'' • - --, ,s, 1 - •• : 1_,-:-. :.•-,--_,,,,„t-7-4,-, •'..;,- / ..• - , , __ - ,„ '''' ' ' — ' . - " #o selc.,p9 - • ' .'', ' - ', .- . ..4,. - : ' *.. ' '2- -., --, . „ ;--.--,,,.. .. -z-- - •,-"5.-4E. ' - - - -; . , - c 5 56 20 \ . • , . - I./. - 22 .0C) 2 , . , -SCAL.E .'41kji?"''''t‘P - • -- . . .. •,. ' AMA 1.2(• ii-S F ,`J / . _,_._— --' . ... . ., ., N/F ) iie,: tsm 1\1Ey ,. 4 — ,.. • .DEED: L. t,t/A R. - ,.• _ . '- ' ':".-: ' : :,'''`','.: 00 . - 1:)'; V't'4-E - • ' TEST HOLE . . • VACA.NT, ) ' GMEt\IT • • - Jnumorked.' 'SatterationTA"Poraddigon - . . b this survey Is a violation of - . t - Section 72011 of be New Yob IIIIIMP • ' 0..._... Education Law. *• :'• . — . . Copies of this survey mop not beenne . . , , . the lend surveyor's ktked seal or - ' ' :. . . embossed seal shall not be considered - ' - J . b be a VaNd in*Cepy." • . ' .7-7- INC' .2EFE.r.-.. 717, t\IAP (2F i$11C,!--!Pt:":1 K.7_ P.-eIE, r,- oNA/5 - a. , -- - "--1/4 r— r-,,) r..-T v r ROPE: , ,‘,—. • „-.. 0"41 0 0. r..- < Guarantees indicated herstss shall tun eillY b the person!althorn the army ,- MAP k_it- is- ispmpared,and on his behalf to the - ' '''' sEci-, • reFE ,,:-.-' ...Er,' i N Ti-1.E 5-Li-FF. --0,...LE12_____k 5 Or P1‘. title . surtv EYED For- _ 06 MAP .10. 89 I-2. 0 “comPanY.govemtrtentai agency and asnaing instituticn iisted hereon and ., _ tu_.......... . ---- -.— ID the assignees ot the lending bed- '''' . , • . ,...,1 r*--, t\ 1 ''---i C. . i i ,i , fution.Guarantees stru not transferable , ..--... ...... . ,--, ,0 , ,1 1 _ 1 / i r I , t-- 1-- 1 \ r , -, t....:kt .• s,-- , u. b adcraional institutions ar subsequent ' i • t ; )• -.47 , : • 1 ' 1 I f \I -, • , ._ !,..._ . 1 ‘,..../ -,,.„.„.• t i ;...,„, •-,....... --.... t-.- t........ 1......, L.....- -- w.-- 7...E-LE\d'A, T. r2EFE 12 7) MEA.t\': SEi. LEVEL. 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