HomeMy WebLinkAboutVerity, Michael 0°t\, 00
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ELIZABETH A.NEVILLE $ti`Z yam►•` Town Hall, 53095 Main Road
TOWN CLERK p :� P.O. Box 1179
y Z Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
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MARRIAGE OFFICER
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RECORDS MANAGEMENT OFFICER '''0 �0'0 Telephone (516) 765-1800
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FREEDOM OF INFORMATION OFFICER '� i��
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2065 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MICHAEL VERITY
Address 1 : PO BOX 476
City St Zip GREENPORT NY 11944
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 #R10-98-0148
Name Of Owner VERITY, MICHAEL
Mailing Address 1 PO BOX 476
City St Zip GREENPORT NY 11944
Property Address 1 160 BROWN STREET
City St Zip GREENPORT NY 11944
Tax Map No. section 48.00 block 3 lot 42.006
Cross Street 9TH STREET
Building Permit Number Cross Reference:
Issue Date: 5/05/99 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE ti� - Town Hall, 53095 Main Road
TOWN CLERK t o= re. ", P.O. Box 1179
k N = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS % v- Fax (516) 765-1823
MARRIAGE OFFICER `Oy�n ���� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER '?� � 4I �' is
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OFFICE
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 3, 1999
Transmitted herewith is a copy of application No. 2151 for a Cesspool/
Septic Tank Construction Permit submitted by:
Michael Verity
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 �/
DISAPPROVE
Comments:
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Dated
Me. s
OFFICE OF THE TOWN CLERK ''•
`FQ�K
TOWN OF SOUTHOLD 4°'
� Application No. a 14,1ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179j Construction
SOUTHOLD,NEW YORK 11971 = T
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crs Alteration
• $10.00 -Residential
Telephone �y -0 it /
(516) 765-1801 : 1 o' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE27€7 3 // 7y
APPLICANT NAME: 71i,--e-%47ato
APPLICANT ADDRESS: 0. �f7fo /g --dr-e- Alvtze
��f -'tom 2/7 /// 5151
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SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTIO O ALT R ION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: v • ,(sex 470
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OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: /77-g' _7
TAX MAP NO. : Section � Block 3 Lot 4/2 • 6
CROSS STREET: . /c-e-4e°
14
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature Applic t
RECEIVED BY:
Town Clerk's Office
DATE:
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TI `:1✓11 YE •_. r.'t'E O:'APPROVAL.
Unauthorized alteration or addition to this document is a violation of Section 7209 SURVEY OF:, %e..41e
of the New YorkState Education Lew.
t 1 2✓_t/1 I I/ .� �� 27 ��
Certifications indicated hereon shall run only to the person for whom It is prepared u�i►� f0.�
and on his behalf to the Title Company,Governmental Agency and Lending To W O
Institution listed hereon,and to the assignees of the lending Institutions or subse- f
poie,,,..1
quant owners. of err l Ole.
Copies of this document not bearing the professional's inked seal or embossed ! VVVV�������V���1 rrl [[[
seal shell not be considered a valid true copy.
The offsets(or dimensions)shown hereon from structures to the property lines are
for c specific purpose and use and,poo S,patios, g areas,re addition to intended tobuildings or aide the nylon of
o her
fences,retaining wells,p planting
construction. it A
The existence of right of ways and/or easements of record,if arty,not shown are SURVEY DATE: PjL 1.ilib SCALE: I :. 'T-�
not guaranteed.
CERTIFIED ONLY T0: I kP �% ' DESTIN G. GRAF
MIL1}1}�IL VE1c�TY DESTIN G.fiRAF V_.
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'LY SEWAGE ,e ,�;;,,, `,�\ LAND SURVEYOR
HIS RESIDENCE w �, 41 /' �)
ro STAND- By ❑ S '' "j y� 73 WOODLAWN ROAD (�
FFOLK COUNTY N„,�/ ROCKY POINT,NEW YORK 11778 `/
DESTIN G.GRAF N.Y.S.LIC No.50067 v'��
I$ERViCES — ,1/4„..4,1, -:;..z...-,:,;,•:,-,,,
s ,, PHONE(516)821-3442
TAX I.D.No. I 000-48-0 3-42•(.v