HomeMy WebLinkAboutFahey, Donald , , t
JUDITH T.TERRY tt
o Town Hall,53095 Main Road
TOWN CLERK k ti Z $ P.O.Box 1179
REGISTRAR OF VITAL STATISTICS O ��, Southold,New York 11971
MARRIAGE OFFICER =yifJW. 0 Fax(516)765-1823
RECORDS MANAGEMENT OFFICER : OI �aidi Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER .i"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1365 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : INLAND HOMES INC.
Address 1 : P. O. BOX 117
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-95-82
Name Of Owner FAHEY, DONALD AND WIFE
Mailing Address 1
City St Zip 0000
Property Address 1 EVERGREEN DRIVE
(LOT 2 - THE WOODS)
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 1 lot 4.002
Cross Street DEPOT DRIVE
Building Permit Number Cross Reference:
Issue Date: 8/14/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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• ���'1p��� IkC�Gy-,
JUDITH T. TERRY � .4
Town Hall, 53095 Main Road
Z ; P.O. Box 1179
TOWN CLERK cze . Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = � Fax (516) 765-1823
MARRIAGE OFFICER VO�W .b ��� _ - Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER - ,1 ,,.'
FREEDOM OF INFORMATION OFFICER ,,,,,,
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department 4 rr,,-
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 24, 1995
Transmitted herewith is a copy of application No. 1415 for a Cesspool/
Septic Tank Construction Permit submitted by:
Insland Homes Inc. for Donald Fahey and wife •
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: .1L / a/ ;P Jc //62v -95- 8Z
Signature
Dated
' OFFICE OF THE TOWN CLERK
Town of Southold Application No. y. ' 77
Judith. T. Terry, Town Clerk PP
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone • Residential `
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
Q.
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE 7/24/95
APPLICANT NAME: Inland Homes Inc.
APPLICANT ADDRESS: P/0 Box 117,Mattituck,N.Y. ,11952
SEPTIC CESSPOOL ##
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
New Single Family Dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Mr.&Mrs. Donald Fahey
OWNER MAILING ADDRESS: P/o Box117,Mattituck,N.Y. 11952
OWNER PROPERTY ADDRESS: Lot #2,The Woods Subdivision
Cutchouge,N.Y.
TELEPHONE NUMBER OF CONTACT PERSON: 298-9696
TAX MAP NO. : Section 102 Block 1 Lot 4.2
CROSS STREET: Depot Drive
BUILDING PERMIT NUMBER CROSS REFEREN E: _
ItlLat
Signature of. pplicant
RECEIVED BY:
Town Clerk's Office —
DATE:
SUFFOLK CO. HEALTH DEPT. APPROVAL
. H. S. NO.
//\./.
),,,/ SINGLE FAMILY DWELLNG.,ONLY
EXPIRES THREE YEARS FROM DATE OF APPROVAL
STATEMENT OF INTENT
/ THE WATER SUPPLY ANO SEWAGE DISPOSAL
SYSTEMS FOR THIS RESIDENCE WILL
<:/.. / CONFORM TO THE STANDARDS OF THE
SUFFOLK CO. DEPT. OF HEALTH SERVICES.
(Si
APPLICANT
t )
ti SUFFOLK COUNTY DEPT. OF HEALTH
Vii` / d a SERV ICES - FOR APPROVAL FOR
GALE - SD= ) CONSTRUCTION ONL 1905
At^?E A: 44,950 5.F DATE: JUN 0 8
_I H. S. REF. NO.: i . 0 -� - a 4'c
iii,-.. APPROVED: Armor
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ri. SUFFOLK CO. TAX MAP nCESIGNATION:
03DIST. SECT. BLOCK PCL.
ICOO 102, I 4.2,
U PLEASE NOTE
co PLEASE ADDRESS:
..=� Minimum distance between well IS JOD1 DRIVE
r-. and cesspool is to be 150 feet. . EASTPORT, N.Y 11941
ill .
TEL.325-134 5
DEED: L.N/A P. I
10TE� TEST HOLE STAMP
I.LOT N05. RE1+E12 I0 MAP OF THE WQO05 AT .
1�ri k-?QC,LSE FILED IN THE StiFF CO,CUE[Z .'S unaunrotzedswam«.ddlgoff
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-'e` F'I:R` f n5 MAP NO 57 I !, SeetIon 7208 of the New York Stas
_e_-t_._ G a SEA r Education Law.
.C! p 1 Fot}1z I'Z EFE+c. TO t"1EAJJ SEA LEVEL. Copies of this survey map bowing
.... _.._�.._____.-- • - fs inked seal or
the land surveyo
embossed seal shall not be cons
ldared
to be a valid true copy.
Guarantees indicatedrrshereon
hom the Survey
shall run
only to the pe
Or
is prepared,and on his agency and
title company.governmental
lending institution listed hereon and
to the assignees of the Nndki InsO-
Q union.Guarantees are not transferable
to additiond Institut::
taUtut or aubae4
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,�
SEAL
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to —
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A') SUR.VEYED MAY 11 1995. % CC.
RODERICK VAN TUYL. P.C. 4 �m o�
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LICENSED LAND SURVEYORS '�SF� LANDS��r
GREENPORT NEW YORK
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S.C. DEPT. 4f ( Haus!✓ ;,,�n�n r--n��crrni
HEALTH SERVICES 1.
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, PLEASE NOTE ,`
Sitary system is not to be
pl� ed under driveway area. (vAcAtiT)
I
LL MAP OF PROPERTY,
A SURVEYED FOIA„
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DONALD Eu 12.
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