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JUDITH T. TERRY Z Town Hall, 53095 Main Road
TOWN CLERK p P.O. Box 1179
REGISTRAR OF VITAL STATISTICS 1 Southold, New York 11971
® �- 9° Fax (516) 765-1823
MARRIAGE OFFICER �' ®I� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER =- hit
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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. 1188 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : PETER DENICOLA
Address 1 : 1695 CHABLIS PATH
City St Zip SOUTHOLD NY 11971
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.
Name Of Owner REGO, NEIL
Mailing Address 1 P. O. BOX 841
City St Zip SOUTHOLD NY 11971
Property Address 1 1695 CHABLIS PATH
City St Zip SOUTHOLD NY 11971
Tax Map No. section 51 .00 block 3 lot 3.017
Cross Street BURGUNDY COURT
Building Permit Number Cross Reference:
Issue Date: 8/29/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK ® • ' F P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS - g ��" Fax (516) 765-1823
tir
MARRIAGE OFFICER '��` �� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '_ _r'l`
FREEDOM OF INFORMATION OFFICER rr�,.
OFFICE OF THE TOWN CLERK f fl IN
TOWN OF SOUTHOLD r 1
AUG 16 1994
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office TOWN BLDG.DEPT.OFSOUTHOLD
DATED: August 16, 1994
Transmitted herewith is a copy of application No. 1234 for a Cesspool/
Septic Tank Construction Permit submitted by:
Peter DeNicola for Neil Rego •
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: 80.../-7/) lea-1447
f
RECEIVED '
3 vs-
AUG 2 6 1994 Signature
outhold r
Town Clerk S Dated /
•
'O7FICE OF THE TOWN CLERK ,,,,""""'
Town of Southold 00"c0f0Litoe'O Application No. /e7T3 `"!
Judith T. Terry, Town Clerk ••�•O�E',. - Gy
Town Hall, 53095 Main Road Z G Construction 1
P. 0. Box 117 9 ;
; 1= -1 • ,�T,
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Southold, New York 11971 cn .S _ yc•• Alteration
Telephone 0 ' `�Q�•• $10.00 - Residential l�
(516) 765-1801 Ol
,, ' $25.00 - Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE it( ,
APPLICANT NAME: ( e be l c o tk
APPLICANT ADDRESS: (G etc' rCpi„ (c L o S N t�
So
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
6 5 P, er2 ebtuAAil /04'4.6 6-6 1-/ek 144
LOCATION MAP: ' Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 1A1 L A5
OWNER,MAILING ADDRESS: PLO,. Y OS
✓
OWNER PROPERTY ADDRESS: (0c'c ( ;i v ;�' ��•-'L
TELEPHONE NUMBER OF CONTACT PERSON: '96 •765- S33/d
TAX MAP NO. : Section dS7•Oo BlockOO .00 Lot 063, 60
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
72,1(0-
Signature of Applicant
•
RECEIVED BY
Tow Clerk's Office
DATE: e • it c( 7
,
ppo P c_P ti SURVEY NO.. 89-073
m/o Chardonnay Woods @ Southold
Filed September 28, 1989 as Map No, 8822
LOT/6)
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t. N. 19° 37' OO" E. /62.67' ,a" o "`/C``"
Ni
I COT/7) CoT/8)
_ ZONED 'A-80" RESIDENCE
_ AREA OF PLOT 40,000! s.f.
PROP. 1st FLOOR /835 9.f.
q� PROP. 2nd FLOOR i_Z'LS s.f
1,\
PROP. BASEMENT i 5- 5 s.f
PRoD PROP. GARAGE ¢Sp s.f.
weta,
N w ASSUMED DATUM. •
vie
t I. s
Z ` There are no surface waters within 300
V, t.. feet of this plot.
N
O AREA = 40,000' S.F. or 0.9/8 ACRES
Unauthorized alteration or addition to a survey map bearing a Professional Land
Surveyor's Seal is a violation of Section 7209,Sub-Section 2,of the New York State
:• Education Law
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1 y t - , Guarantees or certifications indicated hereon signify that this survey was prepared in
jIC) accordance with the existing"Code of Practice" for Land Surveys adopted by the
b� "New York State Association of Professional Land Surveyors". Said guarantees or
certifications shall run only to the person for whom the survey's prepared,and on his
behalf, to the title company,governmental agency, and lending institution listed
O O J hereon and the assignees of the lending institution.Guarantees or certifications are
not transferable to additional institutions or subsequent owners.
I `V N
Copies from the"ORIGINAL"of this survey map not marked with an"ORIGINAL"of
W • the Land Surveyor's"RED INKED"seal or"EMBOSSED"seal shall not be considered
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4.5' 0 to be a valid true cop y
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A I.* 4341 CP [�
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,2.6,-7•\ss .1-1 T .
- • COUNTY TAX MAP NO. /000-05/.00-03.00-003.0/7
CERTIFIED TO:
CHABLIS PA TH
X50' WIDE)
SURVEY OF LAND AT
NAME
NORTH SOUTHOLD
ADDRESS - TOWN OF
PHONESOUTHOLD
The water supply and sewage disposal systems for SUFFOLK COUNTY DEPT. OF HEALTH SERVICES SUFFOLK COUNTY NEW YORK
this residence will conform to the standards and FOR APPROVAL OF CONSTRUCTION ONLY
specifications of the Suffolk County Department of / hereby certify that this map was made Edward A• Bullock, Jr. By E.A.B.
from an actual survey completed by me on Professional Land Surveyor Ft Engineer Health Services. DAIS: H.5. REF. NO.: 01/30/fo rl y 9 DRAWN: W.H.M. //3//89
4�e-tu.. Q • nn 4 L Miller Avenue —
_ ____ APPROVED: a \J�Xxo Port Jefferson Station SCALE.- 1" 40'
Happlicant'S signature N.YS P.L.S. No. 49214 New York 11716
M • N.Y.S. P.E. No. 63675 516-473-5332 FILE NO.: /000-5/--3-3/7
ASSAU SUFFOLK BLUEPRINTING ,.