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OFFICE OF THE TOWN CLERK c.0FOUre
Town of Southold ,¢r OGy
Judith T. Terry, Town Clerk ,4:
Town Hall, 53095 Main Road oma--
P. O. Box 1179 .v' � ,:
01,
Southold, New York 11971 O �0� �••
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Telephone ' [
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 313 Residential X
Fee $
10.00 Non-Residential
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Dennis Ketcham
ADDRESS: 3350 West Creek Avenue
Cutchogue, New York 11935
DESCRIPTION OF PROPOSED CONSTRICTION or ALTERATION
New Single Family Dwelling with Sanitary System.
n _
APPROVED as per Suffolk County E$ alth Department approval.
LOCATION OF PROPOSED CONSTRUC NQALTERATION:
OWNER OF PROPERTY: Denrr€ ECetam
- f
OWNER MAILING ADDRESS: 335 ,West;-creek Avenue
• `Cu gt.ka,.. New York 11935
OWNER PROPERTY ADDRESS : Private Road off Main Road
Cutchogue, New York -
TAX MAP NO. : Section 97 Block 1 Lot 23
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CROSS STREET: Main Road
BUILDING PERMIT NUMBER CROSS REFERENCE:
t'' VVV ® '.7 i•
Judith T. Te ry
Southold T'o'wn .:Clerk
DATE : March 23, 1988 _ f_
(TOWN SEAL)
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A ;{ `` 5 , ;;; Town Hall, 53095 Main Road
,,;;;X;," ' . r� P.O. Box 1 179
s.-„ Southold, New York 11971
JUDITH T.TERRY - r.% TELEPHONE
I OWN CLERK (516) 765-1801
RLGISTRAR 01 \'IT\L S CATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
March 23, 1988
Dennis Ketcham
3350 West Creek Avenue
Cutchogue, New York 11935
Re: Private Road off Main Road
Cutchogue, New York 11935
Dear Mr. Ketcham:
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25. 00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws_ please do rxtr hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truLW yours,
^� L}
'fi
Judith T. Terry
Southold Town Clerk
-Enclosures (3)
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.fP.O. Box 728
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JUDITH T TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD -
• • • March 18, 1988
To: Victor Lessard, Southold -Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 317 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Dennis Ketcham
Please review the application and location map and advise if the
- project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
6004411.11642.11"m..4°.2".....
Judith T. Terry
Southold Town Clerk
* * * * * * * * *
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE - X
DISAPPROVE - -
COMMENTS: 06,0 ,,,,, A,c zt -reL r9_, 1,,..4A,,
Z.e...1 u,..t...' 4:22.--,9a...j-
Signature
'3\'a-3`iii
Date
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OFFICE OF THE TOWN CLERK J ,c0Fitire,
Town of Southold ��.` � 3 �
- Judith T. ` Terry, Town Clerk Application lication No. //�J
Town Hall, 53095 Main Road 2. ; 'Construction
P. O. Box 1179
Southold, New York 11971 0
4� ! Alteration
Telephone _01 ;.a01. 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 /6•
APPLICANT NAME: 6f/7(5 et/C.17,g yy1
APPLICANT ADDRESS: ClYSD l06.5/ (aeC IC._. 1('6
620-74Ch //q3r
SEPTIC CESSPOOL/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
cL() / A,g Co,i5 f",cCl c9 ti/
LOCATION MAP:. Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: / �/J//fS �7c4xlj71
OWNER MAILING ADDRESS: (3,72S---() 43 . eftz'Z,L U�
r Cb a
OWNER PROPERT ADDRESS: 5 V ComS 7 Q (26 X L—Af)6
rr Act
TELEPHONE NUMBER OF CONTACT PERSON: 7�C7 a 'S
TAX MAP NO. : Section MOO Block 0? ) Lot Of
CROSS STREET: "VA/ 44)
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature Applicant
RECEIVED BY: _
Town Clerk's Office
DATE:
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LOAMNIo„ n SURVEY FOR
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2.2' TOWN OF SOUTHOLD
BROWN SUFFOLK COUNTY , N. Y .
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• V The water supply & sewage disposal sys-
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J el 17 '' standards of the Suffolk County Depart-
mr.rt of Health Services.
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N CERTIFIED TO
25� oN - :
X COMMONWEALTH LAND TITLE
0INSURANCE COMPANY.
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5.3T°378. ROOSEVELT SAVINGS BANK
S. 4.3044'40"W. I9•5 • DENNIS KETCHAM
6.65 25 ) CYNTHIA KETCHAM
MAIN
ROAD ( NYSRTE
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SUFFOLK COUNTY NP:.fwT...Z.IT OF Ff;~.•".LTH SE VICES
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�_'__ '�,` ,�� N.Y. S. LIC . NO. 4961 8 LOT NUMBERS RE FE R TO MINOR SUBDIVISION
MADE FOR WILLIAM L. S MURIEL A. MURRAY
PECONIC SURVEYORS S ENGINEERS , R C. FILED IN THE OFFICE OF THE SOUTHOLD TOWN CLERK.
( 516 ) 765 — 5020 _
P.O . BOX 909
:f MAIN ROAD ELEVATIONS ARE REFERENCED
TO AN ASSUMD DATUM. REVISE 3 - 3 - ss ( PROP.H3E. )
SOUTHOLD , N. Y. 11971 Rev I3'a+ 3-4 es
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QK. ' 87 - 1020