HomeMy WebLinkAboutBaxter, Mark egg'OOO
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Town Hall, 53095 Main Road
/� P.O. Box 1179
4701 lit *n °" Southold, New York 11971
JUDITH T.TERRY �� ,�,��� TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 350 R Residential X Non-Residential
Fee $ 10. 00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BAXTER, MARK
Address 1: 30 WELLINGTON PLACE
City St Zip AMITYVILLE NY 11701
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY SUFFOLK COUNTY HEALTH
DEPARTMENT.
Name Of Owner BAXTER, MARK
Mailing Address 1 30 WELLINGTON PLACE
City St Zip AMITYVILLE NY 11701
Property Address 1 MAIN BAYVIEW
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78. 00 block 7 lot 5.002
Cross Street SMITH DRIVE SOUTH
Building Permit Number Cross Reference:
Issue Date: 6/02/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
and
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;' Town Hall, 53095 Main Road
Timm •F S•UTNO
1 : ‘'° •'' P.O. Box 728
a Southold, New York 11971
JUD?I]I T.TERRY TELEPHONE
TOWN CLE R1: (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
May 26, 1988
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 352 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Mark Baxter
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
er •
deorea
Judith T. Terry
Southold Town Clerk
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE - X
DISAPPROVE -
COMMENTS: odaca►�a
moo_
Signature
kfA a---\3
Date
OFFICE OF THE TOWN CLERK SUFFO�
Town of Southold 0. CSG ,�--
Judith T. Terry, Town Clerk Application No.
Town Hall, 53095 Main Road jZC Construction
P. O. Box 1179 �` J Alteration
Southold, New York 11971
Tele hone .4O! 1'b Residential
p ,
(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 $ /0 "
DATE ///Qi alp b b
APPLICANT NAME: I y Lcqu'. GG,, KA-Q.,-
APPLICANT ADDRESS: 3 LOA_I( � -G� PL
A„V t t J l j,o �L "I, 1 /101
SEPTIC / CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
111)42. Lk) 01,AM
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: nflQ u k 8 a -eL,
OWNER MAILING ADDRESS: 3 0 ,,j4) 1(4 -k-K.) v,
W�' /170/
Pi
1'( 1 l - � t���n � (4, //70/
OWNER PROPERTY ADDRESS: 3), sa �-I/) a p sem, ,4
pJ1y,4 0h ma vl c .1 teLii
TELEPHONE NUMBER OF CONTACT PERSON: 6 - / / 7
451
TAX MAP NO. : Section 7 6 Block -7 Lot
CROSS STREET: S u7 6 V I J io 2 4vt+6
BUILDING PERMIT NUMBER CROSS REFERENCE:
RECEIVED
•MAY2 ti 1988 /
TownClerk SoutholdSignature of Applicant
RECEIVED BY : ,-
Town Clerk's Office
DATE:
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APR 6 _ .. I 7 EL•0.5 --J 45 GR.WATER .
1988 ! ' 1 i'
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• S.G. Ttl'1. OF SURVEY FOR
HEALTil SE;£ to
MARK BAXTER
- SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
AT BAYVIEW DATE: MAR. 31,1988
FOR PPROYAL OF CONSTRUCTION ONLY TOWN OP SOUTHOLD SCALE: Ii'= 100' .
SUFFOLK COUNTY, NEW YORK NO. 88-0355
DATE 5-7) 1� 41S REF. NO r� n - C(,
/ j / *UNAUTHORIZED ALTERATION OR ADDITION TO THIS
j / i� SURVEY IS A VIOLATION OF SECTION 72097 OF THE j e
>. NEW YORK STATE EDUCATION LAW E OF !y
4PPROVED *COPIES OF THIS SURVEY NOT BEARING THE LAND S•°P• k'
Jo
�, / SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL
Ci (� U UMOT BE CONS Y
NGUARANTEESINDICATED RED TO BE A VALID TRUE P
HEREON SHALL RUM 10 4,00W i. �*
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT
AND aNTHERSON H BEHALF TO THE TITLEFOR WHOM THEECOMPANY,OoIS VERN- if 4o ' ° . OG
I NEAREST WATER IAINLMI.• *SOURCE OF WATER: PR1ATELPUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED • �` C)
N SUFF CO. TAX MAP DIST 1000 SECTION JUL BLOCK_1-1Z LOTP/O 5002 HEREON,AND TO THE ASSIGNEES OF THE LENDING /' .1(*THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE Y^
OTHER THAN THOSE SHOWN HEREON. TO ADOITIONAL INSTITUTIONS OR SUBSEQUENT '1 .1-.•
OWNERS
III THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR NIS RESIDENCE ti,
*DISTANCES SHOWN HEREON FROM PROPERTY LINESle
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC 4 ��
OF HEALTH S[RVIC S. 434
APPLICANT'. A PROPERTYPURPOSEALINESDRE OR ORNOTTO THE[ STABLISH ERECTION USED TO [OF FENCES 1AMD 5rit ♦
ADDRESS 3C.,1..�ef/�>ci,4.A 1)4 •�l dll1 t(TL- viii., /
,A , ft/Vg1 //1t ( • TEL. -* fiji7�1 YOUNG & YOUNG R�IVOERHEAONNEW YORK
DER E
ALDEN W.YOUNG,PROFESSIONAL ENGINEER
NOTE, LOT NUMBERS SHOWN THUS, (71) HEREON REFER TO AND LAND SURVEYOR N.Y.S.UCENSE NO.12845
SUBDIVISION ..MAP OF GOOSE NECK11 FILED IN THE OFFICE OF
THE CLERK OF SUFF. CO. ON NOV.22,1948 AS FILE NO. 1663 HOWARD W.YOUNG, LAND SURVEYOR
*THE LOCATK111 OF WEL L(W).SEPTIC TANK(STIO CF!TPf)(N VC?)1"44"."'""....." .... - . . .. _