HomeMy WebLinkAboutDickerson, Allan •
JUDITH T.TERRY et° OFF 01
tt"� y- Town Hall,53095 Main Road
TOWN CLERK t y Z ; P.O.Box 1179
rrt
0 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1 Fax(516)765-1823
MARRIAGE OFFICER 4f* 47 Oil
RECORDS MANAGEMENT OFFICER .� * �► ��1 Fax
(516)765-1800
FREEDOM OF INFORMATION OFFICER �. ,is"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1349 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ALLAN C. DICKERSON
Address 1 : 2255 GRAND AVENUE
City St Zip MATTITUCK NY 11952
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. #R10-95-0016
Name Of Owner DICKERSON, ALLAN C.
Mailing Address 1 2255 GRAND AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 PADDOCK WAY
City St Zip MATTITUCK NY 11952
Tax Map No. section 107.00 block 4 lot 2.011
Cross Street OLD MIDDLE ROAD
Building Permit Number Cross Reference:
Issue Date: 7/12/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
• ,,,,,,,,,,,,,,,,
/ 3, *.•-. V
JUDITH T. TERRY % 1'.
Town Hall, 53095 Main Road
TOWN CLERK : o P.O. Box 1179
t to Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = ',' Fax (516) 765-1823
MARRIAGE OFFICER ' ' �.O •�" Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER 4 ,l
FREEDOM OF INFORMATION OFFICER =� ��i, ,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 22, 1995
Transmitted herewith is a copy of application No. 1400 for a Cesspool/
Septic Tank Construction Permit submitted by:
Allan Dickerson
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
DISAPPROVE
Comments: GGU'' C941,7 SC% , 2 f- 0/7z;feigi
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RECIIVED
JUL 1 1 1995 Signature
lava Cid &MN /7/114r-
Dated
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OFFICE OF THE TOWN CLERK ""
Town of Southold et'�stf Ul./(
Judith T. Terry, Town Clerk ;' �l/y=. Application NoN
Town Hall, 53095 Main Road = Construction „...----'
P. O. Box 1179 '� `
co TAlteration
Southold, New York 11971 . VS
Tele hone O�,'� $10.00 - Residential ( %
(5Te 65-1801 =cifoi � IP ��
,'i��,,� ' $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 I(.' \--c-i,) ckc
i
APPLICANT NAME: ,\..4.v\ C ,rCuLerS0-11im
APPLICANT ADDRESS: AdA(Dj4- J
A41 AAAL/ . o ) *\/ , i\o,-,
SEPTIC )( CESSPOOL
DESCRIPTION OF PROP SED CONSTRUCTION OR ALTERATION
N\ ktO ( 2S1c\ Q e-
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: A\ 4 . i r Ll,r a
OWNER MAILING ADDRESS: ZZcc OtAiva LtVe
a 1.-V‘L,\L 1 ' ,\[. \\C -)
OWNER PROPERTY ADDRESS: ?j cAcuc,V W
\V\41 k\ \ ckt, NI ,
TELEPHONE NUMBER OF CONTACT PERSON: S - 2$& - `(CtSI
TAX MAP NO. : Section V)/ Block q Lot Z. i I
CROSS STREET: OW NNAAle Iia
BUILDING PERMIT NUMBER CROSS REFERENCE:
kid,
gnaCies re o Applicant
RECEIVED BY: �T�c �O
ffice
DATE: ,_,,,/2 ,y?7c
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• ! 1 aI t 5 ELEVATIONS SHOWN HEREON ARE FROM TOPOGRAPHICAL
• r •o tZi I 1 •�� / \ G' MAPS PREPARED BY US REFERENCED TO N.G.V.D.(M.S.L.1929)
/ I 116• ,(</C3.):\
\• V,, • O AND ARE SUBJECT TO FIELD VERIFICATION.
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! �" REVISIONS YOUNG & YOUNG
T. o erly
Herr now r form ,4`
nit Louis thlll v SEPT. 14,1994 30 A,tii u„i 4i, Ni h +I_Rh
fr Tu \ OCT. 4,1994 "
II`Al 1 'p l.:PAP ME.N' ,.-.'4 fC. 1P.DP" .JNSTP'.,i Dean ALDEN W 0 N HOK ARO W. YOUNG
PR:FF.551UN4 E .INEF P A IU HV EYOP
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C ':1X A? OISr��SEC ON107 l'-'!CI, OT x.H
*!HERE .RC NO JWE_L•N,5 w THIN 90 FEF- SF •4,5 PROPER Tv SURVEY I(JR.
O'HER THAN 'HOSE SHOwN EPEOH -- - - - -
-IE WATER ;JPPL AN.;SEWAGEJISPOSIL -rSrENFCR THIS RES.JENCE I ALLAN DICKERSON a CHARLOTTE DICKERSON
wIILCONF,'RM TJ THE S'ANDAROS OF'HE <LIFF1LN COUNT.DE?IRTMENT 5 '
OF HEALTH SEav,CES
,„ LOT N0. 12, "WOLF PIT POND ESTATES"
APPLICANT .
10DRE 55 --- suF�K Y SAR I OP WAL�M SERVICE'
MATTI TUCK
_ — — —-- -
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NOTE U=MONUMENT FOUND A.STAKE FOUND / /7 9( S N N F
SUBDIVISION MAP FILED IN THE OFFICEOFTHECLERKOF DATE T!/ G 1 N6 MN. MO O.. 95-00/(o SO----- __
SUFFOLK COUNTY ON JUNE 21,1990 AS FILE NO.8963. i'
14;;.444 /ij---- s-
•,,,.n ���j s "-E I' = 100 AUG. 16, 1990 90-0600
•iME LOCAVON OF nEL ,W!,SE?TIC T1NM(S'iA.:ESS�:J_3(CP)¢MOWN�f 4E0N /' ��. y ,/ ''
ARE FROM F'E,0 095ER vA T:ONS AND OR OATA OBTAINED FROM OTHERS C