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Town Hall, 53095 Main Road
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`'--L* `' P.O. Box 1179
d2 c,m, &;I►I Southold, New York 11971
H
JUDITT.TERRY FAX(516)765-1823
TCLERK ��"���� TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 474 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PECONIC DEVELOPMENT CORP.
Address 1 : P. O. BOX 594
City St Zip MATTITUCK NY 11952
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 2/3/89.
Name Of Owner ROBERT W. KEITH
Mailing Address 1
City St Zip 0000
Property Address 1 WILLIS CREEK DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 10 lot 2.000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 3/10/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
el -7A
t s; Town Hall,
�,� ,� �'A � 53095 Main Road
" + � P.O. Box 1179
oi Southold, New York 11971
JUDITH T.TERRY ��� <�i TELEPHONE'
TOWN CLERK ' (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ti V
To: Victor Lessard, Southold Town Building Department
-61989
From: Linda Cooper, Southold Town Clerk's Office
BLDG. DEPT.
Dated: March 8, 1989 TOWN of SOUTHOLD
Transmitted herewith is a copy of application No. 484 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Development Corp. for Robert W. and Helen W. Keith
Please review the application and locationmapand 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 X
DISAPPROVE -
Comments: qk, .c.,..at c4 1 c .,. a C e. arkr Q .
airbasati . t . 1ikccs*,� 1'. eyvs,
Signature
(as\SG\
Dated
~ t! rrNsNr.
air Pi;
\ !�, psi*. I
Town Hall, 53095
c.r) Main Road
P.O. Box 1179
`r i‘ i Southold, New York 11971
JUDITH T.TERRY �„"roirl / TELEPHONE
TOWN CLERK
(516) 765-1801
REGISTRAR or VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
•
- ' To: Victor Lessard, Southold Town Building Department
From:, Linda Cooper, Southold Town Clerk's Office
Dated: March .8, 1989 -
Transmitted herewith is a copy of application No. 484 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peconic Development Corp. for Robert W. and Helen W. Keith
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:
•
Signature
Dated-
r`
O*FFICE OF THE TOWN CLERK %V_FO(,�
(,,‘
Town of Southold V,;:4.,. ,, . .. L ���
2.A' :: Application No.
Judith T. Terry, Town Clerk a 1,-71 . :,._ ;,:
Town Hall, 53095 Main Road o --••>'1 rK.•=1;, 'r Construction
P. O. Box 1179 � �'"
Southold, New York 11971 O, z- . Alteration
Telephone V.
21[ X°- - 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. ("0
Fee $ k0 ,'
DATE `316 -7 leq
APPLICANT NAME: ----PIZC�, \C- ��A q_.C.0.--1-‘ (\At Kn.- CC(Ads
APPLICANT ADDRESS: .-- -CD , 6 K 4 ctml-CLICK( V _)-.1a_..
SEPTICCESSPOOL
DESCR OTION OF PROPOSED CONSTRUCTION OR ALTERATION
/...,
0°C.,1J-) S 6'N - F-Pron,\ L V ` ...LLL ( N G---
'
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION :
OWNER OF PROPERTY: �(1)--5 U - W , 'Ga- i
\--k
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: LO I �t. . ao_ \-\-041-766./._ J lam 1A'l
ft\ r VT LdL -- w t U, t 5 G(1-44 I b r,
TELEPHONE NUMBER OF CONTACT PERSON: 7 2Z " e76 Z.
TAX MAP NO. : Section /03 Blockrr/' 6 Lot Z
•
- CROSS STREET: Ii of L' S At.._ i
BUILDING PERMIT NUMBER CROSS REFERENCE:_
(4
•
Signature of Applicant
RECEIVED BY:,
Town Clerk's Office -
DATE:
+-
•
•
•
•
THE WATER SUPPLY&SEWAGE-DISPOSAL SYSTFr 3-)rS:
FOR 7P19_,E;... IDENCE WILL: CONFORM TO THE Ll'-'--- -_I,! f'UF:`-a... w1�iJ 1 Y DEPT. OF
;'r::: HEAL)1.
ST;!,AD"''rx" F"THE SUFFOLK COUNTY ,
f'EPF Fc'ffr;aN t HEALTH SERVICES 1 Lu'_�` ' ''! 1.II la/ re.' APPROVAL OF CONSTRUCTION ONLY,
P ,
APP'b NTS-__ __ •�sJ Q� !AT",� ��HS. REF. NO.
' 1329 NORTH SEA RD, A,Q
COUTHAMPTON N.Y. 11968 0 AP,1l;OVED _
PROPOSED
Slit-2B3-6360 03 WATER MAIN
, O
�o
1
m / , '
o i
�/ 12'DRAINAGE EASEMENT {
. n :E�fp� 11''
9 i�o� R�.�UI�ED \ � / 5 3 r
f�C�11AT10�1 INS�EC k - PLEASE NOTE E i
_ -� �!" N Requires septic tank
R-6013 r ' �o cover to grade. -
rJ/ ��OJED ;4 tO e°
-
- P64L E W01'• - - f t ?' , ,
•
= Peor K, - _'`,rj ` wo`' _. , -
•
`TTE./? ER NI 0,1 , i"�A`
V(G NritI , \` - X13•
Ix Y m
16.5' v p M a• Pt'. �� ,` RI -
a Lot 15 xn I$ �:-P4- Y -�,°+L /;,1 Lot17
,,,;,z OGO,OJS v�atZ O 'Sill
14.0 FIN1H�^ GRADE ' J3 � \.77z`,.0,-1,0.,
f` F ra:;. , \.......- O 'il,l
Io o - I O'7- X 3F' ,� ...s•
P %/,' ,
ALT _ ,-.c.. .0 pGo,-� . 1 •{ �•
i�85
I.SEo Ie.7.7 20 :l N --TX € _'='y" i
7-
- 6EPflc T 7.2 - i
E75posL O �_! ' -
• -T
z XT8 a Lot 16 ,,
2.viATE2 EL,=L•1 �j11- N } f
--- --._ D Area=42783s.f. o ;
EV X7.8 , r 1 -
%�(i 1 181y- �E1&/AC't6 DI J�OUJAL UJ`IrEM - 'x75 1 1 D�. �-
UhE 3 QOOL �fSTEvlcs.
`1z�4-- -- a=-------
X83 -J ' '4-,...i.. ��i_= •_.
L4N0 -------'T- `-T--- -- -_
4AD
L4 T _ - —5—_r--------_--_�— __ _
ND L_S____ X74
�QNDS xID 2�AgW• 9 �g0�28'.w �,- -
_ S73o 4 IE LINEALONG --"'� -
`•
APPROX H.W.M I I9a382' -���-� =��'
, vC -mow --
•
•
DEEP HOLE CREEK or W/L L/S ,CREEK' . ,,
•
f-•.._. '— NOTE: �..._._. •
J "
ELEVATIONS SHOWN HEREON ARE _ -
REFERENCED TO N.G.V.D.(MSL 1929). . ! •
SURVEY FOR
"uFFOLK COUNTY DEPARTMENT of HFALfiH gERVICE: ROBERT W. KEITH & HELEN W. KEITH s FT.23'1 seg
LOT NO 16 'HARBOR VIEW AT MATTITUCK" JULY 20,1988
FOR APPROVAL OF, CONSTRUCTION ONLY JuIJE 27,
AT MATTITUCKDEC 23,1987987
DATE
TOWN OF SOUTHOLD
)ATE o�'3 3% HS REF. NO. M.Sc.) 1O NO 87-1480
SUFFOLK COUNTY, NEW YORK SCALE I"=50'
_
/j 72--------
yJ�- - , NUIMUTNORIZEO ALTERATION OR ADDITION TO THIS GUARANTEED T
'PPQOVED / / ��� suRVEY IS A VIOLATION OF SECTION 7709 OF THE ROBERT p(f$TGIFEYVEI N W KEITH
MEW YORK STATE CDUCATION LAW
r COPA ES OF THIS SURVEY NOT
SEARING THE LAHo- CENTI� "511: ORATION
Il/3a,I G� SURVEYORS INKED SEAL OR EMBOSIED TEAL SHALL' CHIC 0 .LL�QN R. ,Q
i I NOT NE CONSIDERED TO SE A VALID TRUE DOPY .�i_ `9'r OMPANY
M GUARANTEES INDICATED,HEREON SMALL RUN ONLY TO .y .Z.� I �G
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUC i THE PERSON FOR WHOM THE SURVEY IS PREPARED T
ANO OI HIS BEHTO THE TITLE COMPANY,LISTSGOVEJRN- y��( T •
N WATER UIM_MI *SOURCE OF WATER PRINTF_PUBLIC J. MENTAL AGENCY AND LENDING INSTITUTION LISTED {LA y
N SWF COTAX MAR MST'AWL-SECTION JZ,Z KOCX ly_LOT 2 HEREON,AND TO THE ASSIGNEES OF THE LENDING ;. I,7-7 yl T
*MERE ARE ND O.rELLUMBS WITHIN 100 FEET OF TIM!PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
N THE WATER SUPPLY AMO SEWASE•DISPOSAL SYSTEM FOR THIS WI I OE MCE OWNERS _ _ ! ry0a
WILL CONFORM TO THE STAMOAROS.OF THE SUFFOLK COUNTY DEPARTMENT TOM$/SMCfS SHOWN HEREON FROM ♦•ROPERiY LIME! •/ Cf 4. 4 I:9 -
OFHEALTH SERVICES TURPOSTING STRUC TURf! AREFOR AT:PECIFIC ,{/•
APPLICANT. PURPOSE AMO ARE NOT 70 BF USED ES TASLISN \-N, S.
!E'IO -
PROPERTY LINES OR FOR THE ERECTION OF FENCES -
AOORESS _
•
TEL • ' YOUNG 8t YOUNG -400 OSTRANDER AVENUE '
NOTE ••MONUMENT p.STAKE • .LATH RIVERHEAD,NEW YORK
SUBDIVISION MAP FILED IN THE OFFICE OF THE ALDEN W YOUNG,PROFESSIONAL ENGINEER
• CLERK OF SUFFOLK•COUNTY,ON AUG.21,1987. AND LAND SURVEYOR Al,YS UCENSE.NO.12845.„- ,,,.3.-_4-.,7.,_,
.- -8�..�.-fk-L.E,No- sa77....,.a. .-�t ;., .�.,.:.�-.,,.fw.__.-_..-".ba.�^�*.=.�- ru,,:a`_ . - .. r..�. ,,