HomeMy WebLinkAboutHendrickson (2) 1117170.
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JUDITH T. TERRY ' t Town Hall, 53095 Main Road
TOWN CLERK p L P.O. Box 1179
REGISTRAR OF VITAL STATISTICS s, .�� Southold, New York 11971
MARRIAGE OFFICER .4 Fax (516) 765-1823
4�® �.V 1! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 822 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : JUDITH HENDRICKSON
Address 1: 9 NARCISSUS ROAD
City St Zip MASTIC BEACH NY 11951
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 4/9/92.
Name Of Owner HENDRICKSON, JUDITH
Mailing Address 1 9 NARCISSUS ROAD
City St Zip MASTIC BEACH NY 11951
Property Address 1 HARBOR LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 103.00 block 1 lot 20.002
Cross Street PIERCE & OAK
Building Permit Number Cross Reference:
Issue Date: 4/10/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK O Gi P.O. Box 1179
REGISTRAR OF VITAL STATISTICS * (lam �.
Southold, New York 11971
MARRIAGE OFFICER %-�� O �4` Fax (516) 765-182365-1
��® ��Q�i!' Telephone (516) 765 1801
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OFFICE OF THE TOWN CLERK g�+�������:,,s,,';
TOWN OF SOUTHOLD
APR 1 01992 ,";pl /it
To: Southold Town Code Enforcement Officer '
131.1 s. cro a.'-° 1—
From: Linda Cooper, Southold Town Clerk's Office TO, _UFSOU L -
Dated: April 10, 1992
Transmitted herewith is a copy of application No. 845 for a Cesspool/
Septic Tank Construction Permit submitted by:
Judith Hendrickson •
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 nn . n
Comments: Q,o ,C,v..��At� [)v.% P ._ .14.4.1,
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ANAstat VlS.c,j-i . IN, q);__
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Signature
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Dated
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•
OFFICE OF THE TOWN CLERK1F0
O
� S
Town of Southold Application No. �y
Judith T. Terry, Town Clerk n,•. �'
Town Hall, 53095 Main RoadX t ,,.;; = Construction
P. O. Box 1179 y
Southold, New York 11971 Alteration
Telephone 76'1 244 11‘&3Residential
(516) 765-1801 "� . Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
. N
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE //0frZAPPLICANT NAME: Jaet/-I 141cle(c/eSo. i
APPLICANT ADDRESS: .iQ.e-C(5J
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
V2-e.t_v � -x�e. xQ., -
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: s j,7Lf fleitde(c,.ro,,v
OWNER MAILING ADDRESS: ? " c(c suJ 1-
e 5 is 1S L, �y //9-5—/
OWNER PROPERTY ADDRESS: c/4—/cc./`t67_,
c2 11,_,
TELEPHONE NUMBER OF CONTACT PERSON: 3 fs= (, O 3 ?
TAX MAP NO. : Section 76 3 Block / Lot J°/D aG_ Z
•
_ CROSS STREET: f0 W(1��
BUILDING PERMIT NUMBER CROSS REFERENCE:.
11,
/ Signature of Applicant
RECEIVED BY: Ul-
�� Town C erk's Office
DATE: /" `( /Or /9 C_
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EDGE OF WETLANDS AS FLAGGFD
... BY YOUNG 8 YOUNG ON I;,'; .. -
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EXCAVATION INSPECTION RELIVED VI, SIVE
NOTE' 1�
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ELEVATIONS ARE REFERENCED TO
1992
APPROX MEAN SEA LEVEL DATUM . • SINGLE FAMILY DWELLING ONLY
. EXPIRES 3 YEARS FROM DATE- OF APPROVAL S.C.s ' °vEs
H
IC
SURVEY FOR
JUDITH HENDRICKSON
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES LOT NO. 2, "BARBARA SOWINSKI1I MAR.12, 1992
NOV. I8, 1991
AT CUTCHOGUE DATE NOV. 5, 1991
FOR APPROVAL OF CONSTRUCTION ONLY TOWN OF SOUTHOLD SCALE: I"= 10d
DAT
SPR Q •
199, G SUFFOLK COUNTY, NEW YORK , _ NO 91 - 0961
REF. NO. .5( .--J-I
M usAUTHORIZEO ALTERATION OR ADDITION ro THIS CERTIFIED TO: •
e c �w SURVEY M A VIOLATION OF SECTION 7205 OF THE JUDITH•! ` - 7 •N
,DoorwFD ' ✓ .��'�./ \ �' MEN YORK STATE EDUCATION LAN AME•- ATF ' • URANCE COMPANY
M COPIES OF THIS SURVEY NOT BEARING THE LAND
S
3 r. r�f/ 1 to : r SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL SH �D w }O,A
CS 1� ' NOT SE CONSIDERED TO BE A VALID TRUE COPY O�'' }O
MGUARANTEES INDICATED HEREON ALL RUN ONLY 10
HEALTH DEPARTMENT-DATA FOR • • • -% • TO CONSTRUCT
THE PERSON FOR WHOM THE SURVEY IS PREPARED t 6
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- � • Z�
♦ MENTAL AGENCY AND LENDING INSTITUTION LISTED ' y
* NEAREST WATER RAIN MI _ *SOURCE OF WATER PRINTF PUBLIC_ _ ` ��
$SUFF CO TAX MAP DIST 1000 SECTION J,o3 BLOCK J—LOT P/0 20.2 HEREON,AND TO THE ASSIGNEES OF THE LENDING
*THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE -1 .1
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT L-,,---
.
OTHER THAN THOSE SHOWN HEREON OWNERS
M THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS RESIDENCE *DISTANCES SHOWN HEREON FROM PROPERTY UNES . $•r•
CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO EXISTING STRUCTURES ARE FOR A SPECIFIC A (1--
WILL
OF HEALTH SERVICES ' PURPOSE AND ARE NOT TO BE USED TO ESTABLISH `S!"jJ .�`Y
APPLICANTS I��// /��n�j,C/��1v� PROPERTY LINES OR FOR THE ERECTION OF FENCES LAND 5)31
ADDRESS ! �a teat ssL(t U/2d •
�aS�c a' L 4/y TEL 3tS- 6°37 YOUNG & YOUNG 400 RAVENUE
RIVERHEAD, NEW YORK
NOTE: IN = MONUMENT Q =STAKE '
ALDEN W YOUNG,PROFESSIONAL ENGINEER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK AND LAND SURVEYOR NYS UCENSE NO 12845
OF SUFFOLK COUNTY ON MAY 17,1991,AS MAP NO.9101.
el HOWARD W YOUNG, LAND SURVEYOR
n *TIE LOCATION OF WELL(W),SEPTIC TANK(ST)B CESSPOOLS(CP)SHOWN HEREON NYS LICENSE NO 45893
m ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS
BRANDIS & SONS INC.