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JUDITH T. TERRY .041 Town Hall, 53095 Main Road
TOWN CLERK p nilP.O. Box 1179
U' Southold, New York 11971
REGISTRAR OF VITAL STATISTICSV® �. o,' Fax (516) 765-1823
MARRIAGE OFFICER /�� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER - O ��
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. 1118 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT W. INGRAM
Address 1 : 14 EASY STREET
City St Zip SAYVILLE NY 11782
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. #R10-94-0029
Name Of Owner INGRAM, ROBERT W.
Mailing Address 1 14 EASY STREEET
City St Zip SAYVILLE NY 11782
Property Address 1 SHIPYARD ALNE
City St Zip EAST MARION NY 11935
Tax Map No. section 35.00 block 8 lot 5.007
Cross Street MARINA LANE
Building Permit Number Cross Reference:
Issue Date: 5/02/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAT 1
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JUDITH T. TERRY : ` ` w Town Hall, 53095 Main Road
TOWN CLERK ® ' s P.O. Box 1179
: ;�' Southold, New York 11971
REGISTRAR OF VITAL STATISTICS -�y ,' Fax (516) 765-1823
MARRIAGE OFFICER _® .���!' Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER �y„0,0y°/ ���
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: April 18, 1994
Transmitted herewith is a copy of application No. 1156 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert W. Ingram •
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. R
Thank you. �-�
K
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8 IN Li
• el�.ol�t
Linda J. Cooper 1 TOWN OF SOUTHOLD
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above -
and make the following recommendations:
APPROVE
DISAPPROVE
Comments: . cSa 4 e7,” / ,e7. ..... 5•1‹,-, 0 -7
'':=:=7`05;? :' r".7 4
Signatur
Dated /�
ce-° - ;, .
OFFICE ;OF THE TOWN CLERK c,\WFULY
Town of Southold 0�� ` . - COG /1/Y(
Judith T. Terry, Town Clerk .t It: . Application No.
Town Hall, 53095 Main Road ' carp �P�, 4 Construction _
P. O. Box 1179 `"
O ® ��`� Alteration
Southold, New York 11971 ''' ' -�.
Telephone • 0 [ 0 •• Residential
(516) 765-1801 - �" Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE ''f — iv^ - 4
APPLICANT NAME: RoL es..�� LU— ( 6u ,,,s.-„c,._„_
zsj
APPLICANT ADDRESS: -( � 1L A S ,
s Ay L _
SEPTIC CESSPOOL -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
i(,/, kU /-4- o.•vL F-
LOCATION MAP: Must be attached hereto-before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: .0k.. ,2-t-v'� ( 6v-1��i----
OWNER MAILING ADDRESS: ( q Q7 S -(.- ,s.
..
i4--y Lith II ( f( . / / / 782
OWNER PROPERTY ADDRESS: L.tC+ a- li ` 5 L.% v „a.‘,-2 1-
c_, 6L4 ti -t - // 939
TELEPHONE NUMBER OF CONTACT PERSON: e..c) Jk ( +v ut' .e-4---------
' TAX MAP NO. : Section Block Lot 67 7
CROSS STREET:
- BUILDING PERMIT NUMBER CROSS REFERENCE:
= 2c,_Qpi l-3V
Signature of pplicant
RECEIVED BY: ( bei/e- 'b*
Town Clerk's Office
DATE: (71-7a /Y
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0 \ Young & Young, Land Surveyors ! I
\ 400 Ostrander Avenue, Riverhead, New York 11901 ell
V°ung \ 516-727-2303 ;IR
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on
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Howard F. Young, Land Surveyor dil
Pie yy ery eG Thomas C. 1Polpert, Professional Engineer o I_
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J / \F? t1 0�iy Kenneth F. A6rl:zzo4P 6. , Land Surveyor i
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CEnginsting
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9\ '9 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE' '
ti
oP`'� R=40.00• \ O FOR APPROVAL OF COT°' =TIO`! GNLY
/ ,-(.• „,...\c/ — -- 0 L.-----6 2.83. \ DATEMAR 31 129i, lu I;LF r o ;- e
�P\a E�'o O�'O \ \ 0'l, °d ; -A'°' '''gym°® �"�.`'t�'' ;ieOf
�'�� �l cQ.` Q�°\ti"�P.* �j 017-;,,IaP APPROVE _- �g
/° J°moo �5$� \ :_<' Sym X50°j's.& x� `00
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Q� c,� \ �< o ,' 4, r cps 1I
/ O� / \\ r\ "�°�' / \ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CERTIFICATION 16N
/ O��G ( '��\ \�\ �b, '' / \ .9J, 1 AM FAMILIAR WITH THE STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE �,
77 SEWAGE DISPOSAL SYSTEIAS FOR SINGLE FAMILY RESIDENCES AND,WALL ABIDE BY THE CONDITIONS is $
• J `A' / D ! ^ SET FORTH THEREIN AND ON THE PERMIT TO CONSTRUCT' f
/ OPS ' \\ \a �� eo r� IP// °i\ ��
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L� �Q� O��Q�\\\o \{o Qce, �0 -,x- .,j A APPLICANTS SIGNATURE: i o
/ (7�L� y,-T7 �\• i Q vC{',2,CT� zF, / \ ANN APPLICANT.
7 \�P ° a rt \\ D 10°('i 0'i, ,-, 4" Qp a// S.k. " \',
FY •
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SWEET• ADDRESS: p
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�P ,.. \p.,, // -bo ryb0 Lj. CITY: STATE. ZIP CODE gEbe
/ /� c2p�ip 1�T / / \•��• °�� TELEPHONE NUMBER. lip
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• >, '' \\\ :' \@,, Qo� F SURVEY FOR: 6 .
• °�'' �Y ROBERT INGRAM & STEPHANIE INGRAMOil
. ,L• • \ At: EAST MARION Town of: SOUTHOLD
i
Suffolk County, New York 11
o� S� \` Ni, apt '`� Suff. Co. Tax Map: I 1000 , 35 8 ,P/o 5.3 �Ill:
��9 ,�' .LSA Ok deo\ Districe Section Block <
s s1,o 5� �\o� Ot `JPco�' T‘\%40-\\,,, $ � I
NOTES:• EY Jyt� r RTC15l' %,.• ox b e
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1. A = STAKE SET �P •�N � '�`?i4 21. 1�9� °
2. SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF \ - -' ` G MAN
SUFFOLK COUNTY ON NOVEMBER 22, 1993 AS FILE NO. 9426. \ = bob]
3. ELEVATIONS SHOWN HEREON ARE FROM TOPOGRAPHICAL MAPS \ FAMILY D 'L����� * F hr. * IApe
PREPARED BY US REFERENCED TO MEAN SEA LEVEL DATUM EXPIFIES THEE YEP,R3 FROh1 DdlTE OF APPROVd!!. .1!....w-,._.:2.11;,4;:
AND ARE SUBJECT TO FIELD VERIFICATION. \ - S c'DEPjpp��O11rFr,,ES
\ \'C1� _,.-1 - gAM1H SEIMAR. 18, 1994 11P,
c S�uAL.-E :1"= 40' eb
\ 6DLANOS\-9` " - JOB NO. :94-0092 11
1
e SHEET NO..1 OF 1 4
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