HomeMy WebLinkAboutDeLuca, Samuel I'''FFOIKCO
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JUDITH T. TERRY L , Town Hall, 53095 Main Road
z ; P.O. Box 1179
TOWN CLERK z G T ,
REGISTRAR OF VITAL STATISTICS in Southold, New York 11971
MARRIAGE OFFICER Fax (516) 765-1823
Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 828 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SAMUEL AND ANNE DELUCA
Address 1 : 1614 FALMOUTH AVENUE
City St Zip NEW HYDE PARK NY 11040
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 4/21/92.
Name Of Owner DELUCA, SAMUEL AND ANNE
Mailing Address 1 1614 FALMOUTH AVENUE
City St Zip NEW HYDE PARK NY 11040
Property Address 1 1350 GLENN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 2 lot 31 .000
Cross Street SHEPARD DRIVE
Building Permit Number Cross Reference:
Issue Date: 5/01/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
JUDITH T. TERRY
$ �L Town Hall, 53095 Main Road
TOWN CLERK : rZ • P.O. Box 1179
REGISTRAR OF VITAL STATISTICS � Southold, New York 11971
MARRIAGE OFFICERy0 - Fax (516) 765-1823
��0 �� Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD 0 cf
JJ\\ APR " 092
To: Southold Town Code Enforcement Officer �'
From: Linda Cooper, Southold Town Clerk's Office T 'tr•
Dated: April 28, 1992
Transmitted herewith is a copy of application No. 852 for a Cesspool/
Septic Tank Construction Permit submitted by:
Samuel and Anne DeLuca
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 `oC
DISAPPROVE
Comments: a-0 ir% cgrckeD•a. r•tdit.v4-4-1 cari
011 pon-t9-2 cQ5.,� .f c CACI. LsS'� s ft. , t.)-Pn
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Signature
3.019
Dated
OFFICE OF THE TOWN CLERK -$.401;
Town of Southold :� )44 Application No.
Judith T. Terry, Town Clerk �� pp
Town Hall, 53095 plain Road +•�F.# Construction
P. O. Box 1179 73'k ' � Alteration
Southold, New York 11971
Telephone
r [ � Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $ /D
DATE 'A
cf--4 ?—
APPLICANT NAME: /7)4t Q./ /47/7) .. /--mac teC
APPLICANT ADDRESS: AdiZ /3,x--0
Q_6.c i o/X--
SEPTIC
-SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
DN rh 7 4.-/ Xk
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: "me ei tie 4"),•9E e�
OWNER MAILING ADDRESS: / -/
p 14.1./. //
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 7
TAX MAP NO. : Section 7 & Block Lot
CROSS STREET: _ ____ -7<_12_.
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
Sig ature of Applicant
RECEIVED BY: ,6//
Town Clerk'sfice
DATE: � ���-
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N SUFFOLK COUNTY[(PAWNOR OF HEALTH SERVICES 40‘X`•
' FOR APPROVAL OF CONSTRUCTION ONLY 4)4.-.V !D
DATEAPR 2 1 142,!4.&REF. • FL... —3-3 •r4 L J
APPROVED (-- ---/f.\
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SINOLE YEARS ONLY
EXPIRE$ N yo
TWO YEARS Fi9CNy DATE OF APWi�OVAL 'E"
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SURVEY OF
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(VACANT 1 STK LOT Q
_ LOT 15 LOT 0 o
�' MAP OF °' oT0—
s "WEST CREEK ES TA TES"
FILED AUGUST 19, .1963 FILE NO. 3848 ��
AT SOUTHOLD ��� 4 ' $
i '�a .�L S
TOWN OF SOUTHOLD �. o
q`� 5, m
== SUFFOLK COUNTY, N Y. , k' eon" 't % "'= N
1000 - 78 02 - 31 .c3 ' °�� 11;N .M ii,.2.
Scale 1" = 40' v
March 1, 1991 ,,,�
APRIL x 1991 AREA =22,999 sq.ft. 1,
4l Mow
A, {4.a /roc O .� ern.
��ANDg p ' '� N �a.
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4„ c m The locations of web and cesawoola shown hereon are from bell - //.7;11:_•__K-7,-.•
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'' - �' Fy observations end or from data obtained from others. L r ;,m:.;:: d-�, ,w
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;r,`lthimoi LIC. NO. 49618 The water and**wags sal rE LaVE ALONG B 88 47'00"W.8570'
Mir► , %r- 8,t.(* Prepared o title accordance with the minimum �° ORawARY HIGH WATER MARK
standards for titN serve a u estabished systems for residence Wil conform AS PER FLED YAP CREEK
ECO • e.:71 -'1— *RS, P.C. y to the standards of The Suffolk Count C
(516)761-5020 by the such use b and improved and ted y
P. O. BOX 909 for use by The New York Stats and Department of Health ServrosR E r
MAIN ROAD TitleAssociatron. ELEVATIONS ARE REFERENCED TO N.G.V.D.
SOUTHOLD, N.Y. 11971 I