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Town Hall, 53095 Main Road
ELIZABETH A. NEVILLE am Gy�►��`
TOWN CLERK � o= !� P.O. Box 1179
y = Southold, New York 11971
REGISTRAR OF VITAL STATISTICS rftFax (516) 765-1823
MARRIAGE OFFICER � y �� ��� Telephone (516) 765-1800
RECORDS MANAGEMENT OFFICER �f41
FREEDOM OF INFORMATION OFFICER = 0� jig ,a"
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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. 1975 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : EDWARD WILLIAMS
Address 1 : P. O. BOX 96
City St Zip EAST MARION NY 11939
Descripton of Proposed Construction or Alteration
ADDITION OF CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM WELLS,
BUILDINGS, PROPERTY LINES AND WATER BODIES. EXCAVATION INSPECTION
REQUIRED.
Name Of Owner DEBRUIN, NANCY
Mailing Address 1 200 GROVE ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 200 GROVE ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 80.00 block 4 lot 19.001
Cross Street REYDON DRIVE
Building Permit Number Cross Reference:
Issue Date: 11/27/98 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
' FFOLj-c / 7J
ELIZABETH A.NEVILLE �I h`Z`� �Gy�; Town Hall, 53095 Main Road
TOWN CLERK ; p .1.4P.O. Box 1179
y Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax��� Fax(516) 765-1823
MARRIAGE OFFICER . y ����� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER : 1Ql �a
FREEDOM OF INFORMATION OFFICER ���
01�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda Cooper, Southold Town Clerk's Office
DATED: November 27, 1998
Transmitted herewith is a copy of application No. 2053 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Edward E. Williams for Nancy DeBruin .
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS: Maintain required setbacks from adjacent wells,
buildings, property lines and water bodies. EXCAVATION INSPECTION
REQUIRED.
Si ature
Ltia.--1 IV?
Date
44,
OFFICE
TOWN OFSOUTHOLD ,' 4 _ Application No.Z03 3
Fi.I7ABETH A.NE VII.1 IP,TOWN CLERK O
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971 Z
tcrri Alteration•
Telephone 0,� �Q .i' $10.00 - Residential
(516) 765-1801 1 41,le $25.00 - Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICAT ION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
APPLICANT NAME: A/4-/tic B ggv/N 1
APPLICANT ADDRESS: ,Zoo Azov€ 12D r;
Sc� kAeAolci, 1Vy Ilci7(
SEPTIC v" CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
400/46--- N4v ),OO 94) s Ac f4hk rv��
cess 0oa 4
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: L/Anc y Of 13,�u, ,v
OWNER MAILING ADDRESS: ?.C7 1)2_0U€
So v`eioci, 'l'Y l i ct -7
OWNER PROPERTY ADDRESS: S
TELEPHONE NUMBER OF CONTACT PERSON: 511 Wins-. 47/7 7-8700
TAX MAP NO. : Section '230 Block Lot /7,
! S
CROSS STREET: kft dcn /3/?
BUILDING PERMIT NUMBER CROSS REFERENCE: o?S,3a.7Z
RECEIVED Gc� Gatec_dvirtv2
Signature of Applicant
RECEIVED BY:
NOV � 7 1998
..E,�Town Clerk's Office
T
DATE: OM1 r
de BRUIN
200 GROVE DR . /
64)., 1.47 -
NYS f:E. t L.5 . # Z6 36o OLD, . , M/,%
//z//f8 3 27
WASHING REMOVE EXIST TRAP
MACHINE
23' 4' HOUSE
PLUG EXIST
INV = 15.6
w
0
2
v
w
APPROX �� NEW TRAP
ESSPOOL a a
in ,I
LOC a tih
0
NEW
= a 1200 GAL
I swSEPTIC TANK
-M. 4
, PLUG EX I ST1. S
CONNECT TO
vEXIST
41 NEW POOL
APPROX LOC
.1
EM
= OF EXIST \
mr SURF ELEV = 15. 1+/-
HIGH WATER IN REYDON HARBOR (670'+/- NORTH )= ELEV 0.0
SEWER SYSTEM 1 " = 10 '
c:\mydocs\dgn\200grove.dgn Nov. 21, 1998 11:53:15