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OFFICE OF THE TOWN CLERK SII-11(x`,
Town of Southold
Judith T. Terry, Town Clerk : `, ,` t
Town Hall, 53095 Main Road _: ,.
P. O. Box 1179 cn ', =:
Southold, New York 11971 �7 0�-��•�
Telephone 0Iil
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 68 Residential X
Fee $ 10.00 Non-Residential
Septic Cesspool X
PERMIT ISSUED TO:
NAME: Ronald and Sheila Ricca
ADDRESS: 27 Lawrence Street
Farmingdale, New York 11735
DESCRIPTION OF. PROPOSED CONSTRUCTION or ALTERATION
Single Family Dwelling
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Ronald and Sheila Ricca
OWNER MAILING ADDRESS: 27 Lawrence Street
Farmingdale, New YOrk 11735
OWNER PROPERTY ADDRESS : Mill Lane
Peconic, New YOrk
TAX MAP NO. : Section 74 Block 2 Lot 12.3
CROSS STREET: Soundview Avenue -
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
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Judith T. Terr
Southold Town Clerk
DATE : November 13, 1986
(TOWN SEAL)
OFFICE OF THE TOWN CLERK
Town of Southold Application No.
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road Construction
P. 0. Box 1179
Alteration
Southold, New York 11971
Telephone Residential
(516) 765-1801 Non-Residential
WECEM.% TOWN OF SOUTHOLD
ik1011 12 lea SOUTHOLD WASTEWATER DISPOSAL DISTRICT
Town Vieth S uta
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. c
Fee •$
DATE /1/42__A%
APPLICANT NAME: q3//k)1 C % A- c( I C C V
APPLICANT ADDRESS: 27 LA-3,12/C� E j
r-hq rQ 61D .1) C-E A LV- '3 S-
SEPTIC CESSPOOL/--
DESCRIPTION OFPROPOSEDCONSTRUCTION OR ALTERATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONS RUCTION OR ALTS TION:
OWNER OF PROPERTY: /L, 1)C_D `mo i� -i l � C C/
OWNER MAILING ADDRESS: 27 . LAfri /e fV C c / i
A /773 ---
OWNER PROPERTY ADDRESS: cnYY1ig,
TELEPHONE NUMBER OF CONTACT PERSON: C5 (6 2 ci 3 g `F D
TAX MAP NO. : Section 7 Block 2- Lot / 2
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
, W/
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Signature of Applicant
RECEIVED BY: C c_t •
Town Clirk's Of ice
DATE: LL , / '
CONC
PROPOSED :....---)\ SLAB
1 LOCATION 3 �D\�`� TEST
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1 AI y�.14VISII-Y Li• 0a,fA NOTE ®= MONUMENT
��// A re Q ELEVATIONS SHOWN THUS• a 4.5 ARE REFERENCED
• L. TO AN ASSUMED DATUM.
NEAREST
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WATER SUPPLYPUBLIC PRIVATEWATEWELLMIL
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TOWN HEREON ARE FROM FIELD p
ED FROM OTHERS i REVISIONS YOUNG AV YOUNG
SYSTEMS FOR THIS RESIDENCE WILL ` ".J AV
COUNTY EPART �T HE=ALTH 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK
ALDER! Md. YOURdG HOWARD W. YO
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PROFESSIONAL ENGINEER AND LAND SURVEYOR
'tf L r:57_6 S-3-3_aqi6 ? Q O N.- LAND SURVEYOR. N.Y.S. LIC. N0, 12043 N.Y S. LIC. NO. 43
ll `o ° ' SURVEY FOR:
([� •
�� \1 f� ,) 0 JNAUTHORIZED ALTERATION OR ADDITION TO _
OI y p THIS OP IS A VIOLATION OF SECTION RONALD RICCA .;� SHEILA RICC
U C 7209 OF THE NEW YORK STATE EDUCATION SHEILA C �i 65 9 dH
LAK'
OF HrAHEALTHRVP �� LOT NO.3 OF MINOR SUBDIVISION SO °11_' r; --4
COPIES OF THIS SURVEY MAP NOT BEARING
M THE LAND SURVEYORS INKED SEAL OR
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A-RUCTION ONLY /)//// 1 y�/VC •
EMBOSSED SEAL STALL NOT Bt CONSIDERED P�� ¢ ��
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TO BE A VALID TRVE COPY ._.,_.