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HomeMy WebLinkAboutLoucka, Bruce • OFFICE OF THE TOWN CLERKQ(K`, Town of Southold • �" Judith T. Terry, Town Clerk Town Hall, 53095 Main Road P. O. Box 1179 *.$ Southold, New York 11971 Off` Telephone 1 4[ (516) 765-1801 ' �� TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 88 Residential x Fee $ 10.00 Non-Residential Septic Cesspool x PERMIT ISSUED TO: NAME: Winds Way Building Corp. ADDRESS: 1020 Glen Road Southold, New York 11971 DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION New Single Family Dwelling LOCATION OF PROPOSED CONSTRUCTION or ALTERATION: OWNER OF PROPERTY: Bruce and Cecilia Loucks OWNER MAILING ADDRESS: 10 Marbee Lane Rockport, MA OWNER PROPERTY ADDRESS: Rambler Road Ext. Southold, New York • TAX MAP NO. : Section 88 Block 5 Lot 36 CROSS STREET: Rambler Road BUILDING PERMIT NUMBER CROSS REFERENCE: Pending Judith T. Terry Southold Town Clerk DATE : December 30, 1986 (TOWN SEAL) S t I,s///Ii ,,,,I ��0O Cy I. --‘44,, ���� Town Hall, 53095 Main Road _ `,����' P.O. Box 728�l y;,�' Southold, New York 11971 -.... /. JUDITH T.TERRY TELEPHONE TOWN CLERK (516)765-1801 REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD December 24, 1986 To: Victor Lessard, Southold Town Building Department . From: Judith T. Terry, Southold Town Clerk Transmitted herewith is a copy of application No. 94 for a CONSTRUCTION or ALTERATION Permit for a cesspool or septic system submitted by Winds Way Building Corp. for Bruce and Cecilia •Loucka. Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if we may issue the permit. Please complete the form below and return it to my office. Thank you. e,lgged°;afiligr:".. ira""ft Judith T. Terry Southold Town Clerk * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendation: APPROVE - DISAPPROVE - COMMENTS: v Signature Date 91 OFFICE OF THE TOWN CLERK OCjVFFOUre. Town of Southold Application No. Judith T. Terry, Town Clerk 1 Town Hall, 53095 Main Road . Constructioncn "PR P. O. Box 1179 wqFAlteration Southold, New York 11971 �� - Telephone !'2l 4 ' 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 $ DATE /y1)"43/1� - APPLICANT NAME: /1/Albff 4/ &JD ,1/b (/7 J APPLICANT ADDRESS: /OA) ‘/4-/t/ �� SEPTIC CESSPOOL V DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION vwa :6y pH/y/4/6LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CON TRUCTION R ALTERATION: OWNER OF PROPERTY: _ t c,1- 2, 0. OWNER MAILING ADDRESS: /0 `ioitbetar Zthiad- OWNER PROPERTY ADDRESS: 42/11 ,• TELEPHONE NUMBER OF CONTACT PERSON: 76 )--- /3,1 613-19 Q 0.76,^100(t) TAX MAP NO. : Section p ir Block_ ,5 _.._Lot 3C CROSS STREET:_BUILDING PERMIT NUMBER CROSS REFERENCE: Signature of Applicant RECEIVED BY: cu,tc,C,, � ' - RECEIVE�own GClerk'�ce DATE:_ DEC241986 Town Clerk Southold 0 Title No. 7908-r7O823 P i ' Cci I 1, - /---- 0 33 f Y (qa`c.) / /9 v' \ i �,\ res.) T.N.�' .\ i� 0) . cati,L4:: # ,,,,, _ PC. �3Ys �o A tv t0 __ �" i ,ti / 4 c5 .i � - g \•`6_ CJ°'` / .1 ' /ir f Fi ,P lv ' ' /6 2 / rti o �L.::: • • % � • t'acl,17 �O f S•0 i I 0 fy -r- 4_•-.., `-L-1 n c." I *J . .icer : Lo+ (Iu+':Ler:: Shown rel-r5.►- r--) "iVla 7 C7- —it rt-t; Wcy+e ;' filed rn -/-ho 5 uti::,1k C.outr-fq Jerki ;< a rti1.7p N0, 9Q: . I SUFFOLK CO. HEALTH DEPT. APPROVAL H. S. NO. N c, . W al T- =r?OPF`k �' N '::-LJ '/C.'"_--:'F r7:0w / /--\1 !F.--' I;•' STATEMENT OF INTENT �....f��%,,.........?(---...r-----4 THE WATER SUPPLY AND SEWAGE DISPOSAL AT I SYSTEMS FOR THIS RESIDENCE WILL Bi- ' IvEw" CONFORM TO THE STANDARDS OF THE .I CGri S TI- OL:'' , i\I.T: SUFFOLK CO. DEPT. OF HEALTH SERVICES. (S) APPLICANT • SUFFOLK COUNTY DEPT. OF HEALTH 13�Q, SERVICES — FOR APPROVAL OF • IllS r L \ CONSTRUCTION ONLY a-c DATE: �Pt. d� 1 a n ON cS © ) 3 a / H. S. REF. NO.: (fro34g-)-f�S� Ooh L.If APPROVED: 1 :1Vi- L,,kc-i 0 (1,„10-14 lsrN»s L`'a••`) i SUFFOLK CO. TAX MAP DESIGNATION: I , DIST. SECT. BLOCK PCL. Scat e : 50 '= I ” 1 1000 088 5 3(0 Area •:= IO.r90 34'ff , j OWNERS ADDRESS: - o -2. ircdr )if LGU!:lG.: II LONGVIEW LA. • i' SOU T7 40L O.N.'1: !1971 •, Elevat-ic)w f ef-Et- ,O „ a-F ord. is i 3 it w i:crr ir, F cotiic c',a i. DEED: L.7248 P.479 4CF) TEST HOLE STAMP UNAUTHORIZED ALTERATION OR ADDITION 10 THIS SURVEY IS A VIOLATION OF SECTION 7269 OF THE NEW YORK STATE -k31�ii EDUCATION LAW. - -- -` - I. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL :DCI fft EMBOSSED SEAL SHALL NOT BB CONSIDERED • TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PE!•.SON FOR WHOM THE SURVEY IS PREPARED. AND O.:HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED H.EEON, AND CYD • TO THE ASSIGNEES OF THE LENDING TRANSFTI SYtci SUTTON.GUARAN EES ARE ERABLE TO ADDITIONAL INSHTUTIONS OR SUBSEQUENT t OWNERS. cyr:rveI SEAL :..a."-rrrrte'ci ro -:',.,.-.-• (-71,,-., C: 7.I.1 , in .JrcFFICA. 111 7I!Tc/ • ,:11;',TI •O +-7.... f I:O17 Scrvit:q; t-l'c7'ri I RODERICK VAN TUYi_, P.C. N` t"r LICENSED LAND SURVEYORS GREENPORT NEW YORK 1 ' —