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JUDITH T.TERRY Town Hall,53095 Main Road
TOWN CLERK % H = P.O.Box 1179
REGISTRAR OF VITAL STATISTICS 'i'. � Southold,New York 11971
Fax(516)765-1823
MARRIAGE OFFICER ;�� ap��0, Telephone(516)765 1800
RECORDS MANAGEMENT OFFICER c 1 �► �
FREEDOM OF INFORMATION OFFICER ���,,, ,•••�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1347 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : LISA MCELROY
Address 1 : 15 HELOCK ROAD
City St Zip MT. SINAI NY 11766
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. #R10-95-0056
Name Of Owner MCELROY, LISA
Mailing Address 1 15 HEMLOCK ROAD
City St Zip MT. SINAI NY 11766
Property Address 1 LONG CREEK DRIVE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 52.00 block 8 lot 2.000
Cross Street PARK LANE
Building Permit Number Cross Reference:
Issue Date: 6/26/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : =v T P.O. Box 1179
ch �� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = VO �. Fax
Fax (516) 765-1823
MARRIAGE OFFICER .O Tel (516) 765-1801
RECORDS MANAGEMENT OFFICER 'VJ 4 it
FREEDOM OF INFORMATION OFFICER ,,,,,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
JUN 19 pg
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 16, 1995
Transmitted herewith is a copy of application No. 1398 for a Cesspool/
Septic Tank Construction Permit submitted by:
Lisa McElroy •
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 APPROVE !/
DISAPPROVE
Comments: R�G...� y SC/76 ,4, ilio -9347 1od.S_Z
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Signature 411/
Dated 2f i �
111
OFFICE OF THE TOWN CLERK ••,,,,"""
Town of Southold •'� IfOtx�'� Application No. /3ig
Judith T. Terry, Town Clerk •' G
, Construction
Town Hall, 53095 Main Road Z ' „,‘".1
' :C
P. O. Box 1179 rT. �
Southold, New York 11971 �cn ���• Alteration
Telephone 44/ $113.00
�Q �i $10.00 - Residential
(516) 765-1801 = 1 ,, ' $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 Cp l l(Q I
APPLICANT NAME: Lt-SA lMCSkrei
APPLICANT ADDRESS: t`S - f Mt,c,K cc 1
SEPTIC ><-- CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
of\) Y\g1fP CRIAA "t•voelli n�
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Li sc tM( 6hr0"f
OWNER MAILING ADDRESS: ( S 1 (2,0
Itil�- \cir., N .)e. 4
'? OWNER PROPERTY ADDRESS: ,•91&,7
e7_ - /1 ?-7L
TELEPHONE NUMBER OF CONTACT PERSON: jI .), q7c/—3/ 1/ "7
TAX MAP NO. : Section W Block Q ' Lot 60 Q._
CROSS STREET : k. La ry
BUILDING PERMIT NUMBER CROSS REFERENCE:
0 `0 q 1 c ,
Signature of Appli$nt
RECEIVED BY : - jf
Town Clerkrk
's Office
DATE: eo
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Stow 14
NOTE : P11.1t TO
ELEVATIONS SHOWN HEREON ARE FROM ACTUAL SURVEY AND ARE CowQse
REFERENCED TO N.G.V.D.(MSL 1929). SAND
11.0
SURVEY FOR MAY 30,1995
LISA A. Mc ELROY MAY 9,1995
LOT 2 'LONG POND ESTATES, SECT. I APR. 13,1995
MAR.23,1995
aUFFOIK COUNTY aarAismalei Of Wool soviet. AT SOUTHOLD DATE FEB.23,1995
FOs KFFIOMM a OWLY TOWN OF SOUTHOLD SCALE 111 = 50'
JUN
F.�_gS.-Oo,5e SUFFOLK COUNTY, NEW YORK — NO. 95-0072
DATE
JV^ 16 N UNALITNORI ION OR ADDITION TO THIS CERTIFIED TO '
SURVEY M A VIOLATION OF SECTION 1209 OF THE ,
LISA A. McELROY
NEW YORK STATE EDUCATION LAW SCTIC,INC. i.
*COPIES OF 11413 SURVEY NOT BEAR/NO THE LAND
AMBO NOT BE SURVEYOR'S ON!DERED TOL OR BE A VALID EMBOSSEDSEAL
COPYHALL
' NGUARANTEES INDICATED HEREON SHALL RUN ONLY TO .` ��-
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED
AND O/ HIS BEHALF TO THE TITLE COMPANY,GOVERN- °M
N NEAREST WATER MAINMI.I *SOURCE OF WATER PRIWTE-_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED *IS : '
H SUFF CO.TAX MAP DIST IQOO SECTION AiL BLOCK-ail-LOT MIL HEREON,AND TO THE ASSIGNEES OF THE LENDING f;,;^ A , <,.
*THERE ARE MO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE NOT TRMISFERABLE 1j OTHER THAN THOSE SHOWN HEREON. TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT C..
M THE WATER SUPPLY AMD SEWAGE DISPOSAL SYSTEM FOR THIS ROIDEMC[ OWNERS L-, ...
*DISTANCES SHOWN HEREON FROM PROPERTY LINES
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC _ I 1
OF HEALTH SERVICES. I PURPOSE AND ARE NOT TO BE USED TO ESTABLISH 'J�"F�/_ri�r'."'��
APPLICANT. PROPERTY LINES OR FOR THE ERECTION OF FENCES
i
ADDRESS
TEL YOUNG a YOUNG REAR E
RIVERHEAD,NEW
NOTE!II=MONUMENT FOUND 0'MONUMENT SET NINE EIEER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK ALDEN W.YOUHG,PROfESSiONAALD LAND SURVEYOR N.Y.S.LICAL E GEER
OF SUFFOLK COUNTY ON DEC.27,1985 AS FILE NO. 8037
(3el•'NUMBERED LATH SET HOWARD W.YOUNG, LAND SURVEYOR
*THE LOCATION OF DELLO),SEPTIC TANKISTIB CESSPOOLS(CP)MOWN HEREON N.Y.S.LICENSE NO.45893
ARE MOM FIELD OOSENIMIIONI MID OR DATA OBTAINED FROM OTHERS
RRANDIS A SONS INC. 1046