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ELIZABETH A.NEVILLE ?II�0 ^' * ��; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
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REGISTRAR OF VITAL STATISTICS �, : s Southold, New York 11971
®' Fax (631) 765-6145
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MARRIAGE OFFICER 1
RECORDS MANAGEMENT OFFICER =��(% ,,��22, *�®�II� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMI
CONSTRUCTION OR ALTERATION PERMI
SEPTIC TANK or CESSPOOL
Permit No. 2337 R Residential X Non-Resi•ential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : KENNETH WEYCHUK
Address 1 : 116 TIMBER DRIVE
City St Zip CALVERTON NY 11933
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-00-0110
Name Of Owner GIANNONE, ROY
Mailing Address 1 117 BLOOMINGDALE ROAD
City St Zip LEVITOWN NY 0000
Property Address 1 5807 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 113.00 block 12 lot 6.000
Cross Street WESTPHALIA ROAD
Building Permit Number Cross Reference:
Issue Date: 6/07/00 Elizabeth A. Nev Ile
Southold Town Clerk
(TOWN SEAL)
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(93 37
ELIZABETH A. NEVILLE t$ � �; Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS /'
Southold, New York 11971
MARRIAGE OFFICER :®�y O ������ Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER 'Pl®i ,,ss22, iii®e.° Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `Ls' ��'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 5, 2000
Transmitted herewith is a copy of application No. 2425 for a Cesspool/
Septic-Tank Construction Permit-submitted- by:
Kenneth Woychuk for Roy Giannone - -
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 location map of the project cited above
and make the following reco endations:
APPROVE
DISAPPROVE
Comments:
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OFFICE OF THE TOWN CLERK I COk
TOWNOFSOUTHOLD ���� `�G= Application No
ELIZABETH A NEVILLE,TOWN CLERK � O ?
P.O.BOX 1179 • Construction
SOUTHOLD,NEW YORK 11971 = 1.71 Alteration
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Telephone : ,��D ��� $10.00 - Residential
(516) 765-1801 _ 1 ,0 $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE „104/6- oe, 0200a
APPLICANT NAME:
APPLICANT ADDRESS: //6
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SEPTIC x CESSPOOL X
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION , ' e.z,'
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Roy //1-,(/`/i/'0/(/%g
OWNER MAILING ADDRESS: 1/7 •BL erfrV ti9Dif-LC- RD
OWNER PROPERTY ADDIM: /E57Tf'-/L/// ? ,Q •
114A-T'/ T1,tC-4, Al .
TELEPHONE NUMBER OF CONTACT PERSON:63J 7271,7 I yc/fx
TAX MAP NO. : Section amp Block /2- Lot 6
CROSS STREET: Gves4�G,-/� R441)
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature 94plicant
RECEIVED BY: A
.Town Clerk''S fice
DATE:, =—
S C.T.M NO. [..STRICT: 1000 SECTION: 113 BLOCK: 12 LOT(S):6
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COUNTY 1 OFHEALTH SE�tVICdS BROWN
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SINGLE:FAMLLY PJ SJD NCE ONLY
�O .> REF TO. \�lDa,,b 0
COX NECK ROAD (C.R. 84)DATE S:L `AA ` /� - —
APPROVED NO WATER
POR MAXIMUM OF-4-:
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4-25-00
EXPIRES 1 FIRES YEARS FROM DATE OF AP?u ELEvQN ASSUMED
AREA: 87,465.7 S.F. OR 2.0 ACRES ''TuM'
UNAUTHORIZED ALTERATION OR ADDITION TO THIstgemvseefrilrrierri57237 SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS717UTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS
AND/OR SUBSURFACE STRUEYUR£S RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: KENNETH & DOROTHY WOYCHUK;
MAP OF:
FILED •
SITUATED AT•MATTITUCK
TOWN OF: SOUTHOLD KENNETH M. WOYCHUK L.S.
SUFFOLK COUNTY, NEW YORK Land Surveying and Design
(4....,AV M0%� Calverton, New York 11933
FILESCALE: 1"=AO' DATE: APRIL 21, 2000 PHONE (516) 727-5127 Fa (516) 727-5127
#20-80 N. Y.S.UC NO.50227 maintaining the record.of Robert L Hennessy ,