HomeMy WebLinkAboutDavison, Eugene (2) �^ F CIL,, >
Town-Hall, 53095 Main Road
VS 0, P.O. Box 1179
<�'✓� �'+'r� Southold, New York 11971
JUDITH T. TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR QF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
December 1, 1987
Eugene Davison
4300 Sound Avenue
Mattituck, New York 11952
Re: Cesspool System for Stable
Dear Mr Davison:
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ' ($10.00) for
residential use and twenty-five dollars ($25-00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly yours,
Judith T. Terry
Southold Town Clerk
Enclosures (3)
JTT/Ijc
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OFFICE OF THE TOWN CLERK S��FRA-
Town of Southold
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179
Southold, New York 11971 O
Telephone
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 260 Residential X
Fee $ 10.00
Non-Residential
----
Septic Cesspool_`
PERMIT ISSUED TO:
NAME: Eugene Davison
ADDRESS: 4300 Sound Avenue
Mattituck, New York 11952
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Cesspool System at Stable.
APPROVED as per Suffolk County Health Department approval , _
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Eugene Davison
OWNER MAILING ADDRESS: 4300 Sound Avenue
Mattituck New York 11952
OWNER PROPERTY ADDRESS : 4300 Sound Avenue
Mattituck New York
TAX MAP NO. : Section 121 Block 3 Lot 5
CROSS STREET: Bergen Avenue
BUILDING PERMIT NUMBER CROSS REFERENCE: 16372Z
Judith T. TegVy
Southold Town Clerk
� l
DATE : December 1 , 1987
(TOWN SEAL)
R
S�FFDtk
o �o�
`Y �'�► ' Town Hall, 53095 Main Road
oil " •��0� P.O. Box 728
Southold, New York 11971
JUDITH T.TERRY TELEPHONE
TOWN CLERK (S16)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
November 30, 1987
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 264 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Eugene Davison (New system at stable)
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.
Judith T. Terry
Southold Town Clerk
I have reviewed the application and location map of the project
cited above and make the following recommdtndation:
APPROVE - X
DISAPPROVE -
COMMENTS: '
14
41
L) "J �
Signature
3,0/ 9 7
Date
OFFICE OF THE TOWN CLERK
Town of Southold
Town Clerk Ci► Application Noc 6
Judith T. Terry, k 1
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 n Alteration
Southold, New York 11971 ��-
Telephone �l [ 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 Sr
APPLICANT NAME: e V G L,—"L+— Zs V I S C>
APPLICANT ADDRESS: 4 3 0C, So v r4
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: I S G cam/
OWNER MAILING ADDRESS: A13oy So cJALJ> 0
M/9 T r i v c--le - i S 3' Z
OWNER PROPERTY ADDRESS: -S t
TELEPHONE NUMBER OF CONTACT PERSON: :2 Qj z, 64 (!
TAX MAP NO. : Section 1 -2 1 Block S Lot 5�
CROSS STREET: 9 c'q Ge-l'i )4
BUILDING PERMIT NUMBER CROSS REFERENCE:
t
Signature of Applicant
RECEIVED BY: c�G�Cet�
weveown erk's O ce
DATE:
• Town Clark SOt#"
i
NOTICE OP INSPECTION COMPLETION
- SEWAGE DISPOSAL
No.AL•WATER SUPPLY
{ Job � � t -qv1 -7
isposal System InSmIction Completed-OK to Backfill
❑ Inspection Not Completed:
❑ Water Supply Inspection Completed-OK to Backfill
❑ Inspection Not Completed:
Date VI spected by A
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
INSPECTION COMPLETION DOES NOT CONSTITUTE APPROVAL OF INSTALLATION
REV(3185)
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SUFFOLK CO.. HEALTH DEPT. APF
H. S. NO.-_ `'C
Q.,-t Q�,
�-UGEWIE,�,-�,-F TJ "lAt.,
STATEMENT OF INTENT
THE WATER SUPPLY AND SEWAGE I
� 1� +5� SYSTEMS FOR THIS RESIDENC lT-
CONFORM TO. THE STANDARDS
SUFFOLK CO. DEPT. OF HEALTH S
APPLICANT
COUNTY DEPT. OF
`,� �" lY SER111.GES FOR =APPROV!
44 CONSTRUCTION ONLY
-
.
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NSREF N - -
APPROVED
_ SUFFOLK CO.TAX MAP DESIGNA
DIST. ' SECT. BLOCK
OWNERS ADDRESS:
DUN
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DEED: L,6634:-:l'.-,-K5.5.2
TEST HOLE STAMP
—44
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-Ift�!:W 'ED JULY 4oli9ey--F�FT. i�,-1987;OC� l,1,198-1 SEAL
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GRAX,,' L
RODERICK VAN TUYL, P.C.
ti LICENSED LAND SURVEYORS r:r
t GREENPORT NEW YORK