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ELIZABETH A. NEVILLE t OGy� • Town Hall, 53095 Main Road
TOWN CLERK yZ • P.O. Box 1179
v Ali Southold, New York 11971
REGISTRAR OF'VITAL STATISTICS
MARRIAGE OFFICER :Oy ���I'' Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =-'"0l 4.'100 Telephone (631) 765-1800
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. 2424 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WILLIAM ACKERMANN
Address 1 : 14035 ROUTE 48
City St Zip CUTCHOGUE NY 11935
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 #R10-00-0194
Name Of Owner ACKERMANN, WIILIAM C
Mailing Address 1 PO BOX 487
City St Zip CUTCHOGUE NY 11935
Property Address 1 13936 ROUTE 48
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 108.00 block 3 lot 7.000
Cross Street ELIJAHS LANE
Building Permit Number Cross Reference:
Issue Date: 10/10/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �� yet: Town Hall, 53095 Main Road
TOWN CLERK ; y P.O. Box 1179
REGISTRAR OF VITAL STATISTICS , Southold, New York 11971
MARRIAGE OFFICER . 4 ���1'' Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER __ O �a001,� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER � ',1°I"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 6, 2000
Transmitted herewith is a copy of application No. 2514 for a Cesspool/Septic Tank Construction
Permit submitted by:
William C. Ackerman
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:
ignature
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a
Dated
OFFICE OF THE TOWN CLERK 11�'C.l{ DLK4
TOWN OF SOUTHOLD , �' �I Q ;` Application No. �S 1
1:f
LLIZABETH A.NEVILLE,TOWN CLERK
i
PO.BOX 1179 Construction✓
SOUTHOLD,NEW YORK 11971
Alteration
Telephone ,0,j�� V
�Q�is $10.00 - Residential
(516) 765-1801 - I l 1,►0'" $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE /0/670 U
APPLICANT NAME: wk 1' t\CI l/V @ _ 4.../ke...A7(446. 0 `-
APPLICANT ADDRESS: 1 035 6 ` f
/ (,,.,1-c.40,5,,cf, (uy ( I c3 r
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSp CONSTRUCTION OR ALTERATION
b/.0.e_thaj
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALLITERATION:
OWNER OF PROPERTY : W kl\\Ct vt^ C - {i s2niw.Q t--)
OWNER MAILING ADDRESS: I (io3S 10 4.9) - 0. 66)c 4.0j
g_tA .ou , A) LI 93S`
OWNER PROPERTY ADDRESS: I q&0 14e- 48
TELEPHONE NUMBER OF CONTACT PERSON: (0.3(-7P1- 01° 6--- .
TAX MAP NO. : Section t,',../r; Block U%%, 03 Lot 07
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CROSS STREET: E l(j(N�tS • 4, /1 4T
BUILDING PERMIT NUMBER CROSS REFERENCE:
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Signature of Applicant
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RECEIVED BY
own Clerk's Office
DATE: � O
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GROUND ELEV. 40.4
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REV 37.4
PALMINN FIVE 70 COARSE(WO 8111
L W. ri4 NO%ATER ENCOUNTERED
EXISTING BARN TO REMAIN
F.FLOOR ELEV.43.4
1 --i EXISTING BARN TO BE REMOVED
1&42.GLfrl 4•1"°"'.1 EXISTING BARN TO REMAIN
a� { M'' F.FLOOR ELEV.42.4
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YELL I (41.1)
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ER SERVICE
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(40.8) (40.9) PROPOSED DWELLING
AI!:_I�il �iiii l' _B!!.. F.FLOOR ELEV.424
'RESIDENCE i� jijl9_ GARAGE ELEV.41.8
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5D WATER SERVICE (419 iii i� ,g1,.,'.
"2) 14T~ (41.2) T+„riA—rz- ,.`e.
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8.min,..„,"lk /e r 10'min. TESTHOLE ELEVATION=40.4
(47)
PROPOSED SEPTIC SYSTEMS
BUILDING DETAIL EXISTING ELEVATIONS()
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NOTE:ALL F1 FI
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
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PERMIT FCR APYTT'/.L OF CONSTRUCTION FOR A
SINGLE FAMILY RESIDENCE ONLY
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DAN. I0-3--CVCuI:_I •�. u,�u_°/'
APiii'J'li:;f �/
• FC'P:i;,, ,I Y OF 1 DE
EXPIRES THREE YEARS FROM DATE 0 ROYAL
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CERTIFIED TO:
WILLIAM C. ACKERMAN
THERESA ANN BOYLE-ACKERMAN
e PROPOSED DWELLING
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• LAWS MillEFORI POP ONOTIM1N0lMDU!
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DANIEL P. JEDLICKA
PROFESSIONAL LAND SURVEYOR