HomeMy WebLinkAboutDickerson, Thomas Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
JUDITH T.TERRY } TELENIONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
December 12, 1986
Thomas A. Dickerson
P.O. Box 268
Mattituck, New York 11952
Re: Corner of Sound Avenue & Aldrich Lane
Mattituck, New York
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)
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OFFICE OF THE TOWN CLERK
Town of Southold DSO Dy
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road
P. 0. Box 1179 to
Southold, New York 11971 O �-
Telephone 49
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
.Permit No. 82 Residential X
Non-Residential
Fee $ 10.00
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Thomas A Dickerson - -
ADDRESS: P.O. Box 268
Mattituck New York 1195
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New Single Family Dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Thomas A. and Catherine Dickerson
OWNER MAILING ADDRESS: P.O. Box 268
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Corner of Sound Avenue & Aldrich Lane
Mattituck New York
TAX MAP NO. : Section 120 Block 3 Lot 8
CROSS STREET: Corner of Sound Avenue & Aldrich Lane
BUILDING PERMIT NUMBER CROSS REFERENCE: 15559
Judith T. Terry
Southold Town Clerk
DATE: December 12, 1986
(TOWN SEAL)
OFFICE OF 'THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk Application No.
Town Nail, 53095 Main Road Construction—
P. 0. Box 1179 Alteration
Southold, New York 11971
Telephone 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 $ 0
DATE"
APPLICANT NAME: (C j<t=_1zSOn�
APPLICANT ADDRESS: Po -Z6s '
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION _
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : ����
OWNER MAILING ADDRESS:�� � ___
OWNER PROPERTY ADDRESS: --A
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TELEPHONE NUMBER OF CONTACT PERSON:_ T4.dE- 1-w-fc&'St'rJ 2gh47oo
TAX MAP NO. : Section^ .E3lock 03 —Lot_�Q_� T __
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:_�1���
Signature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE: RECEIVED
DEC 1116
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'i SURVEY FOR
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SUFFOLK COUNTY DEPAaMENT OF HWTH SMKMs THOMAS A. DICKERSON $ CATHERINE M. DICKERSON
FOR APPROVAL OF CONSTRUCTION ONLg AT MATTITUCK DATE: JUNE 6 1986
?OWN OF SOUTHOLD
SCALE: 1"= so'
DAT �eF No. a(�-f SUFFOLK COUNTY, NEW YORK NO. 66-468
1 *"UNAUTHORIZED ALTERATION OR AD01710N TO THIS
SURVEY IS A VIOLATION Of SECTION 7209 OF THE
4PP�OVEI3 '// i NEVI YORK STATE EDUCATION LAW
*"COPIES OF THIS SURVEY NOT SEARING THE LAND SEPI OF �� }
cqiSURVEYOR'S INKED SEAL OR EMBOSSED SEAL SMALL
NOT BE CONSIDERED TO BE A VALID TRUE COPY P•aD Ib ,p-
I *"GUARANTEES INDICATED HEREON SMALL RUM ONLY TO 0dt JI_
'. HEAITH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED r 1-1,,
ANO ON HIS BEHALF TO THE TITLE COMPANY,GOVERN-
BUFF
WATER CAIN MI.: *SOURCE Of WATER PRIVATE PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED
M Siff CO. TAX MAP DIST�SECTIO*_=_BLOCK-Q,�_LOT-RijW_ HEREON,AND TO THE ASSIGNEES OF THE LENDING v'�
:THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE I '
OTHER THAN THOSE SHOWN HEREON. TO ADDITIONAL INSTITUTIONS OR SU&SEOUENT
M THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS 1,
WILL CONFORM TO THE STANDARDS Of THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY ONES /Y
OF HEALTH SERVI'C(ES. TO EXISTING STRUCTURES ARE FOR A SPECIFIC 11
AlPLICANT= USED TO ESTABLISH
1�-(0L� C_ATikep,4p G�S6,J PROPERTYPURPOSEAND LINESROR FORNOT7THEEERECTION Df FENCES (AMD
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ADDRESS 1��O ��CZ�v �l ` / ---
rUCk .NT TEL. :L9 �i 47CC., YOUNG a YOUNG 400
OST"NDERNEW YORK E
NOTE o M=MONUMENT 6=STAKE
ALDEN W.YOING,PROFESSIONAL ENGINEER
AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
1F THE LOCATION OF WILL(W),SEPTIC TANK(ST)&CESSPOOLS(CP)SHOWN HEREON L14
HOWARD W.YOUNG, LAND SURVEYOR
ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED PROM OTHERS N.Y.S.LICENSE NO.45893
HNANp1S A 80NS INC. I046
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