HomeMy WebLinkAboutBecker, Brian I' -,
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JUDITH T. TERRY z •L ; Town Hall, 53095 Main Road
TOWN CLERK =v T P.O. Box 1179
tJ'� �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = yv a . et Fax (516) 765-1823
RECORDS MANAGEMENT OFFICERMARRIAGE OFFICER _=� 0 ��1 Fax
(516) 765-1801
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. 1253 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : BRIAN AND KAREN BECKER
Address 1 : 421 EDWARDS AVENUE
City St Zip CALVERTON NY 11723
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. #R10-94-0102
Name Of Owner BECKER, BRIAN AND KAREN
Mailing Address 1 421 EDWARDS AVENUE
City St Zip CALVERTON NY 11723
Property Address 1 1435 ACKERLY POND LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 69.00 block 5 lot 7.003
Cross Street LOWER ROAD
Building Permit Number Cross Reference:
Issue Date: 11/28/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
D-
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oc5�FFOLK v
JUDITH T. TERRY : < ; Town Hall, 53095 Main Road
TOWN CLERK =v T P.O. Box 1179
• Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = �. 4� Fax (516) 765-1823
MARRIAGE OFFICER '=' �� " Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ,l 4
�
T it.
FREEDOM OF INFORMATION OFFICERlllill'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: November 25, 1994
Transmitted herewith is a copy of application No. 1299 for a Cesspool/
Septic Tank Construction Permit submitted by:
Brian and Karen Becker
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 t�
DISAPPROVE
Comments: , �� ) 19/1160
1" ` "0 — 9 -0/0
Alb•
Signatureivy
Dated/ y—
IFFICE QJ THE TOWN CLERK """'---
c Town of Southold
Judith T. Terry, Town Clerk ,4' Application No. is 97
Town Hall, 53095 Main Road Construction
P. O. Box 1179x+ ` Alteration
Southold, New York 11971
Telephone � � $10.00 - Residential 1
(516) 765-1801 1 �'" $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 11 ias--
APPLICANT
NAME: r a V� e,f r2 h �,e �• IL
APPLICANT ADDRESS: tE d UJ �� c /� �,-� u-42
Cck —r—n �U y 1/ 7 3 -t
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: r�ctkiLre" r
OWNER MAILING ADDRESS: 40,. / F-Lvari$ 4U-e_
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CC.(lArfor\ sJ- HHC93
OWNER PROPERTY ADDRESS: I " 3 5 itck 1)/ 4 n4
taLG.(-
0 c a & - /1 77/
TELEPHONE NUMBER OF /COgNTACT PERSON: (.5 ) 7a7- 1.5---(.(,/
TAX MAP NO. : Section 1p { Block 5 Lot 7, 3
CROSS STREET: 14V J 2 ci ' <l yKe_.. kc u r cL
BUILDING PERMIT NUMBER CROSS REFERENCE:
of Applicant
RECEIVED BY:
6finature
Town Clerk's Office
DATE:
/
�`T SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CT }
/ FOR APPROVAL OF CONSTRUCTION ONLY N �C p/� `�
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DATE1 -_- REF.NO.
�=� ",O �s`S0. p. c4,•` o y< ,tiiaF O� APPROVED �r___
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Q.x ins nim YEARS FR01!DATE OF APPROVAL ..• �b 'LQ.
LEASE NOTE N 9 5•
a
Mini sn distance between well �f' g w'�(i
2
cess
is to be 150 feet. V`
and � � �
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4 F,,� O��// SURVEY OF
9s 41- Z z LOT 3
° � "PURITAN FARMS"
,�° °-\ �0, FILE NO. 9538,FILED JULY 19, 1994
N f Qlrs� n�eioP �_- D�#1 AT SOUTHOLD
�o I�'., e "� �"' STOF�OLN�COUNTSOUTHOLD
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O v 6. BR/AN J. BECKER I'f)
(v�° KAFRFENO LM. CBOECNKER Scale 1"- 60'
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NZ AO� ASTATE GENCY OCT NEW YORK MORTGAGE BANK OCT 17, 1994 OCT 21 M
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11 S.C.DEPT.OF
woDr ►fix o'� ,AREA =25093 Acres ';'. "SERVICES
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{ ` 'E•L' /an fa liar ,W Ma STAADARDS FAR APPROVAL
b9t AND CONSTRUCI7ON OF SUBSURFACE SEWAGE // , i 496/8
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riE eY' 1 DISPOSAL SYSTEMS FAR SMILE FAMILY RESIDENCES / ' IL,IA
• jt. M bnI 7!E LAIw AhC and wig ad►da by Nob coni//(a sat forth Mort*, and on Ma -ECOMC UR
wail to construct 0161 765 - 5020 3a�
• P. O. BOX 909
MAIN ROAD
,FRFNCFn To AN ASCuUF" (A'f 84 SOUTHOL D, N.Y. /197/
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