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ELIZABETH A.NEVILLE 0Gy Town Hall, 53095 Main Road
TOWN CLERK o ; P.O. Box 1179
Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS 47 Fax (516) 765-1823
MARRIAGE OFFICER
1i� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
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. 2200 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EARL BROCK & MARGARET LUCE
Address 1 : 290 KOKE DRIVE
City St Zip SOUTHOLD NY 11971
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 #R10-99-186
Name Of Owner BROCK, EARL & LUCE, MARGARET
Mailing Address 1 290 KOKE DRIVE
City St Zip SOUTHOLD NY 11971
Property Address 1 380 HOPE LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 59.00 block 9 lot 26.012
Cross Street SOUNDVIEW AVENUE
Building Permit Number Cross Reference:
Issue Date: 12/21/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
_ow
to A
ELIZABETH A.NEVILLE • Town Hall,53095 Main Road
TOWN CLERK o P.O. Box 1179
REGISTRAR OF VITAL STATISTICS v. � Southold,New York 11971
MARRIAGE OFFICER / Fax(516) 765-6145
RECORDS MANAGEMENT OFFICER '66 a ��� Telephone (516) 765-1800
FREEDOM OF INFORMATION OFFICER =.'�' �`1•����
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
•
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 3, 1999
Transmitted herewith is a copy of application No. 2289 for a Cesspool/
Septic Tank Construction Permit submitted by:
Earl D. Brock and Margaret Luce
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 re )an endations:
APPROVE
DISAPPROVE
Comments:
O
Signatu
AT
Dated
— aI I
,,,,,,,,,Ilii,',•
OFFICE OF THE TOWN CLERK �''���I O�K
TOWN OF SOUTHOLD k4' . CrV Application No.,
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 FF Construction OL
SOUTHOLD,NEW YORK 11971 T Alteration
Telephone O,y �Q�'i: $10.00 -Residential D�
(516) 765-1801 �l �,��'� $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 - z73,/frg
APPLICANT NAME: �s�eL Z•elo.e/e- L4CG--
APPLICANT ADDRESS: ,9d /a/c . e S�a-40" -
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
A/C/1)
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 6
OWNER MAILING ADDRESS: }O /" 2
OWNER PROPERTY ADDRESS: Ma ye7 L•9.��
TELEPHONE NUMBER OF CONTACT PERSON: 7GS-/ -5-3
TAX MAP NO. : Sectionre5-7 Block O 9 Lot 06//-
CROSS STREET: ,i-t/,y2) t//�G)
•,`
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatur of Applicant
RECEIVED BY : �S
Town Cler 's Office
DATE: /
.t
/.
A
CERTIFIED TO:
Earl D. Brock SURVEY OF PR OPERT Y
Margaret Luce
Fidelity National Title Insurance Company of New York
, AT SOUTHOLD .
T O WN OF SOUTHOLD 1 I'
if
Is
$ AREA = 1.9559 ac SUFFOLK COUNTY , N. Y.
4 1000-59-09-26.f2
�$4 �►p� `�sa� SCALE: f"-=50
R�
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'7.► SUFFOLK COUNTY DEPARTMENT OF EIFAl,7TiS8R
10
PERMIT FOR APPROVAL OF coranurnot4 FORA /
(g) . Pe90 Novsr)an o1TiGLE FAMILY RESIDENCE ONLY ..zu
tt DATBNOV .:. 19" Rio— . 9 ibl-e
/ —� � `ot APPROV8D ' . gor .
r Ix EAN Ilk/
? . e
FOR MAXIMUM OF BED. .,•, , •
WM&COLLAR '�) \ EXPIRES THREE YEARS FROM DA'•OP APPROVAL
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weir ie„, 2 ps
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r ir• �- am familiar with the STANDARDS OF APPROVAL
at*4 �� Iwar
I OF ' wy- AND CONSTRUCTION OF 'SUBSURFACE SEWAGE
>� *4 III ' -, b DISPOSAL SYSTEMS FOR SINUL E. FAMILY RESIDENCES
y s . : and will abidersby the Condit' t set forth therein and
— /2• ---Ili �� r �' , . � � •+ *� on the permit to construct
1 AMP *it lett ZIP The locationswof wells and Fr,ols shown hereon ore
from field observations arid 'N data obtained from others.
��•• No .52. 4,0
F''� •
•
-.,•FESSIONPi' Elevations ore referee 0.1 V-115,.. ed datum.
Y.S. LIC. NO. 49618
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION 'i CONIC . EY ', P.C.
OF SECTION 7209 OF THE NEW YORK SATE EDUCATION LAW ( 6) 7
T65 .a 50 )
EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICATIONS • 9. ,.BOX -I09/'
HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF a
SAID MAP OR CQIES.BEAR THE IMPRESSED SEAL OF THE SURVEYOR - •CYC j BEET 99.---2Z
�.+ a sP •
,
WHOSE SIGNATURE APPEARS HEREON. SOb 16E;DU 11971 e7 r+Qtr