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ELIZABETH A.NEVILLEI *-A: Town Hall, 53095 Main Road
TOWN CLERK y = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Vab '�4 Southold, New York 11971
Fax (631)
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RECORDS MARRIAGEMANAGEMENT OFFICER OFFICER `= 0� 1.„01,�� Telephone (63 6576541800
FREEDOM OF INFORMATION OFFICER go ig1
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2436 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JONATHAN MUDD
Address 1 : 22540 MAIN ROAD
City St Zip ORIENT NY 11957
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 #R10-00-0226
Name Of Owner ANGELSON, PERRY
Mailing Address 1 PO BOX 311
City St Zip GREENPROT NY 11944
Property Address 1 350 STRATMORS ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 21 .00 block 1 lot 12.000
Cross Street ROCKY POINT ROAD
Building Permit Number Cross Reference:
Issue Date: 10/18/00 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE l C. ` ' Town Hall, 53095 Main Road
TOWN CLERK yamP.O. Box 1179
REGISTRAR OF VITAL STATISTICSriv 7 `<'' Southold, New York 11971
MARRIAGE OFFICER � y Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ;'*0l �a�,'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ,��
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 17, 2000
Transmitted herewith is a copy of application No. 2524 for a Cesspool/Septic Tank ALTERATION
Permit submitted by:
Jonathan 1\Iudd for Perry Angelson
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: Maintain required setbacks from adjacent wells, buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
Signature
ro/:'1IOC
Dated
OWFICE OF THE TOWN CLERK "ie-If 14 ��''�
t TOWN OF SOUTHOLD �� `QGy'� Application No�s /-
ELIZABETH A.NEVILLE,TOWN CLERK /�
P.O.BOX 1179 Construction 1 <___
SOUTHOLD,NEW YORK 11971 ; Alteration
Telephone ,y �Q�i�,, $10.00 - Residential �\
(516) 765-1801 '_ el �;" $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 k0"' 1C4'' o°
APPLICANT NAME: _T-too 6+6,4--,„) ryI
APPLICANT ADDRESS: 2Z5)6 (YIA-;N �Gr 6 f � Q K)1 1 1951
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
').2.e -\_:C_ + Ct � C--
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : Qe('o�
31 (
OWNER MAILING ADDRESS:
)3 -� a
OWNER PROPERTY ADDRESS: J-(��--{r►c,
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TELEPHONE NUMBER OF CONTACT PERSON: -32-
TAX
j2TAX MAP NO. : Sectionc9143 Block Lot
ca_
CROSS STREET: '12,oGg,
BUILDING PERMIT NUMBER CROSS REFERENCE:
1111k riut/etyjr
Signature of Applicant
RECEIVED BY : /CZ_ S
Town Clerk's Office
DATE: 7 /7 7/05'
SIJUV?'Y OF LOT 6 N
MAI:" OF STRATMORS ESTATES
7 WILE No. 3123 W -...;.‘tL
E
SITUATE, EAST MARION
TOWN: SOUTHOLD S
SUFFOLK COUNTY, NY ,, , i 1 _
SURVEYED 09-15-2000VA( ANI
N79°01'20"E 100.00' "—
SUFFOLK COUNTY TAX # 5� x o�
11000-21-1-12 _ HmT1 _ _-..--
CERTIFIED TO ))' I X m .1 c
( PERRY ANGELSON x .x U DD v
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MELINA ANGELSON / I C 13 — -1 qrc-1
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NOTES: h `'1 " * .........1In••••I.." ...:."•G:
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AREA = 200b4 SF OR 0 4 ACRES ; 1.,n's a ,...-:n,...‘. JOHN C. EHLERS LAND SURVEYOR
1 ",i 6 I4ASI'MAIN N IRI?IiT N.Y.S.I.1(.NO.50202
GRAPHIC SCALE I". 20' E RIVERHEAD,N.Y.11901 1
REF server\d\PROS\20-250.pro
1111 369-8288 Fax 369-8287