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HomeMy WebLinkAboutBerry, Mark osocof �o tx�y'= JUDITH T. TERRY �, ` L Town Hall, 53095 Main Road TOWN CLERK : p rZ P.O. Box 1179 REGISTRAR OF VITAL STATISTICS in �` Southold, New York 11971 MARRIAGE OFFICER 0 �- , Fax (516) 765-1823 ��� � Telephone (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. 816 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : TINA M. BERRY Address 1 : P. O. BOX 100 City St Zip CUTCHOGUE NY 11935 Descripton of Proposed Construction or Alteration NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ON 3/2/92. Name Of Owner BERRY, MARK E. AND TINA M. Mailing Address 1 P. O. BOX 100 City St Zip CUTCHOGUE NY 11935 Property Address 1 DONNA DRIVE City St Zip MATTITUCK NY 11952 Tax Map No. section 115.00 block 16 lot 9.000 Cross Street NEW SUFFOLK AVENUE Building Permit Number Cross Reference: Issue Date: 3/31/92 Judith T. Terry Southold Town Clerk (TOWN SEAL) r\.. gI� ' o ' JUDITH T. TERRY Z %.`‘‘ Town Hall, 53095 Main Road TOWN CLERK ; G T i P.O. Box 1179 REGISTRAR OF VITAL STATISTICS : Southold, New York 11971 MARRIA(�F. . = C-i Fax (516) 765-1823 �"" = 0 �Q���' Fax (516) 765-1801 ni6 j .... ii/iii Fs ' .iT 1MAR2 41992 �� r 4 OFFICE OF THE TOWN CLERK fl 6*\,........„ TOWN OF SOUTHOLD TO'J'Jl'a To: Southold Town Code Enforcement Officer From: Linda Cooper, Southold Town Clerk's Office - Dated: March 24, 1992 Transmitted herewith is a copy of application No. 839 for a Cesspool/ Septic Tank Construction Permit submitted by: Tina and Mark Berry . 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. , /4�4-1---61 61 G' Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE ,C DISAPPROVE Comments: .Q„o y,,. c. aQe e% car►.ci...4 VA.5 �-„ cam.. Ic CA . ��x C. it'. 1. ,,,, 3\Z`ENa. \((..,t_rs,&01.41. Signature 3,\ .,\C\• ....., Dated t r - 1 - . OFFICE OF THE TOWN CLERK Oc;VtFOj,� Town of Southold . -,-,:.; f; • A Judith T. Terry, Town Clerk � Application No. ?S =' Town Hall, 53095 Main Road , =`� Construction P. O. Box 1179 Southold, New York 11971 p• • Ar- Alteration Telephone 1 i 1y�1� 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 r1-ri 1e 1 C3 J, / d- APPLICANT NAME: , APPLICANT ADDRESS: R,(:) . x v Cmc outs / eV //135- ,SEPTIC ✓_ CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION K 1) `-), l /i:„.��li / 6 �-C-2 1 U LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: m A)\ c- 'nig 01 . 0.1"Cf / pQgO/ �o OWNER MAILING ADDRESS: ' . . CA,td-1,0'. y,1/431, AN ia,--W OWNER PROPERTY ADDRESS: 6 �X K,L.� ' TELEPHONE NUMBER OF CONTACT PERSON:/ ) / c TAX MAP NO. : Section I'5- Block / CQ Lot CROSS STREET: —net i)A Q.,..9-Z BUILDING PERMIT NUMBER CROSS REFERENCE:_. Signature of Applicant RECEIVED BY : /1--i To n Clerk's O .ce DATE: 4 C • `x^_.- I - 'ti'E•,-L SUFFOLK CO.HEALTH UtY1.grrr<u vas ...,:f001.. i _ P2EVICAJSLY H.'S.*66-SO•Ie I It I / J. H.S. NO.�, '{ 5 92 7 C255POOL5 _- i • . 1. vf,It 1 RESIDENCE.-SEPTIC LDCA. co Q tsar A(,.1'" .1'4U, UNAVAILABLE I ��� 10 I�64 A�1'� STATEMENT OF INTENT PP.T.H Ci 1 "� 10 vW108 PATH THE WATER SUPPLY AND SEWAGE DISPOS __ SYSTEMS FOR THIS RESIDENCE WI +o , 5.87.19'20 E. 1820• -_.-_ . CONFORM TO THE STANDARDS OF lh 3 �q, SUFFOL •. 0,= ,. • EA T SERVIC) Marv.wZLL C� d t �WELL APPLICANT al I _? racy. -. Pox sonic cess mot_ 1 • i J N ! r I j_ r. � SUFFOLK COUNTY DEPT. OF HEAL C► ` p• 1 SERVICES���Q- FOR APPROVAL PI 5 S . - `b I CONSTRUIMUL UL1 a 4a SIi / 53' DATE: _7--� I y H.S.REF.NO.: n -S)i --4.__, CP ,' Q '„nd.-- rRQP. 1 ? 1 / ✓ APPROVED: JJ SCALE-40'•I" 3SAOJ," g 3o0— J V i 4 -`ry — c2rVE ---ii 35 . ar w Ill- ! b �t J AREA+2A•O20 S.F. SUFFOLK CO.TAX MAP DESIGNATION:; 3 kJ\ :} ^' `N ` ©•MONUMENT DIST. SECT. BLOCK PC t; 7 N i Or PIPE 1000 115 16 9 ti NO Q —— OWNERS ADDRESS: til v._ 19^�Jyw, 182.0 f � Po.6ox COO I di Yj D `�►" "1u,�QQ; CESSPOOL CUTCHOC,UE,N.Y. 11975 Gi GE55rt]Dl9 w ci 30. 64 ,:. J •I 54' ?34 522S E:°. C SfDEiJCE) C IDELKE) DEED: L.N/A P. i LL TEST HOLE STAMP P; 2 NiG{j 3 7 NOTES —_ I. WT Fi1S:.�'F R 7�JoiW . H C.F. R ATE3" FILED 1144 1111E 5UF"F,_06.C1liact tr3PR1%#8.Itg NO4256 il irtle c,PY 2,ELEVATIONS REFE R.T0 MEAN SEA LEVEL pR E MAP OF OP QTY 0 SURVEYED FOR w SINGLE FAMILY DWELLING ONLY C AF2V. BEI-212Y ,EXPIRES , YEARS FROM DATE OF APPROYAL SEA r AT o '�. ; , MATTITUCICfi ; � t��c� TOW.n/N OF 5OUNQLP N.Y 5u1zvE! JAN.30j992, ` "� • ROD�RKIG VAN T�YL.P•C 7 �\2O' s zael� IG .w..,7`....Xt SFp LANCS. ' LICENSED LAND SURVEYORS. l GREENPOIfT NEW YORK 4` • rtao,,.4s: ••z. a