HomeMy WebLinkAboutDoherty, Eugene /��oie FO�,f
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ELIZABETH A. NEVILLE ���02 y Town Hall, 53095 Main Road
TOWN CLERK t o P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER Fax (631) 765-6145
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RECORDS MANAGEMENT OFFICER =y_'j1p1 -01.,„0
'� Telephone (631) 765 1800
FREEDOM OF INFORMATION OFFICER _ southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No. 4127-R Residential X Non-Residential
Fee $ 10.00 New X Existing
Name Of Owner DOHERTY, EUGENE F.
Mailing Address 1 58 DEER VALLEY DRIVE
Mailing Address 2
City St Zip NESCONSET NY 11767-0000
Property Address 1 4095 MILL LANE
Property Address 2
City St Zip MATTITUCK NY 11952-0000
Owner Telephone No. 631-979-6291
Tax Map No. section 107.00 block 4 lot 2.007
Cross Street WICKHAM AVENUE
Issue Date: 1/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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• ELIZABETH A.NEVILLE ,$1= G'yd; Town Hall, 53095 Main Road
TOWN CLERK o - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS G �
V 1%
Southold, New York 11971
MARRIAGE OFFICER ,jiL �1 Fax (631) 765 6145
RECORDS MANAGEMENT OFFICER �__-7�1 .4)401°••
•••• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER r�'r southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2724 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EUGENE DOHERTY
Address 1 : 58 DEER VALLEY DRIVE
City St Zip NESCONSET NY 11767
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 #R10-01-0010
Name Of Owner DOHERTY, EUGENE
Mailing Address 1 58 DEER VALEY DRIVE
City St Zip NESCONSET NY 11767
Property Address 1 14095 MILL LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 107.00 block 4 lot 2.007
Cross Street WICKHAM AVENUE
Building Permit Number Cross Reference:
Issue Date: 1/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
I,,O,oS�FFO�,�c_ `�
ELIZABETH A. NEVILLE a� OG'fd; Town Hall, 53095 aim Road
TOWN CLERK % o % P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ` 0
O Fax (631) 765-6145
MARRIAGE OFFICER : 1if. `�,1,�
RECORDS MANAGEMENT OFFICER �;_-7Q1 �aTelephone (631) 765-1800
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FREEDOM OF INFORMATION OFFICER _ ���� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department ,` . E' �!
'1J,L11 Lai 9 UR I—)
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 8, 2002 TOWN o ',._:Th!ow
Transmitted herewith is a copy of application No. 2819 for a Cesspool/Septic Tank Construction
Permit submitted by:
Eugene F. Dpoherty
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.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: I +."7
l ,e,ri..- .'-
l/`
Signature
oVO i'/0 z
Dated
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OFFICE OF THE TOWN CLERK 'CS FOL,rCO •. �,
TOWN OF SOUTHOLD �� �j Application No ' `C
ELIZABETH A.NEVILLE,TOWN CLERK $10.00 - Residential
P.O.BOX 1179
SOUTHOLD,NEW YORK 11971 f:�1 $25.00 - Non-Residential
Telephone _ej * �1�Oe'"
•
(516) 765-1801
TOWN OF SOUTHOLD
•
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
OPERATION PERMIT
SEPTIC TANK or CESSPOOL
Operation Permit No.
Fee $ •
DATE /0
OWNER NAME: EUfrEJF F Doilifit-ri
OWNER MAILING ADDRESS: Zs" ._FEjj f J,t,E P„/
� E.'Co N SE-T- ► / 76"7
OWNER PROPERTY ADDRESS: 440 9,.' Mak 491M /10-77 TU Cic
OWNER TELEPHONE NUMBER: / '-(3 / 979`('291
TAX MAP NO. : Section /O 7, 00 Block Lot 2 ► 0 0 7
CROSS STREET:
TYPE OF SYSTEM: Septic Tank New Existing
Cesspool ✓ New � Existing
Residential ✓ Non-Residential
LOCATION MAP: Must be attached hereto before permit may be issued.
(Locate building and system; give north arrow and feet
of distance, approximately, to building and closest road.)
"Era
Signature of Ap cant
RECEIVED BY: /V
v
To n Clerk's Offic
DATE: /
0!3,
Young & Young, Land Surveyors
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If . 400 Ostrander Avenue, Riverhead, New York 11901
. v 516-727-2303
66,g 1
i A 4SE
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• Alden W. Young, P.E & L.S. (1908-1994) '15
Howard W. Young, Land Surveyor
Thomas C. Wolpert, Professional Engineer
Kenneth F. Abruzzo, Land Surveyor
John Schnurr, Land Surveyor
. .
NOTES:
1. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK o
COUNTY ON JUNE 6, 1990 AS FILE NO. 8963.
2. M = MONUMENT FOUND
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