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HomeMy WebLinkAboutRichardson . JUDITH T.TERRY � Town Hall,53095 Main Road TOWN CLERK kg P.O.Box 1179 1 1 Southold,New York 11971 REGISTRAR OF VITAL STATISTICS Q Fax Fax(516)765-1823 MARRIAGE OFFICER �;�® ®'� RECORDS MANAGEMENT OFFICER l Telephone(516)765-1800� �� 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. 1260 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : SAMUELS & STEELMAN ARCHITECTS Address 1 : 25235 MAIN ROAD City St Zip CUTCHOGUE NY 11935 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. #R10-94-0094 Name Of Owner RICHARDSON, FRED & MARY Mailing Address 1 P. O. BOX 12521 City St Zip PITTSBURGH PA 15241 Property Address 1 7930 INDIAN NECK ROAD City St Zip PECONIC NY 11958 Tax Map No. section 86.00 block 7 lot 7.003 Cross Street ROBINSON LANE Building Permit Number Cross Reference: Issue Date: 12/12/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) e .. 70Z6.6 De" JUDITH T. TERRY % Town Hall, 53095 Main Road TOWN CLERK ® P.O. Box 1179 to � Southold, New York 11971 REGISTRAR OF VITAL STATISTICS Fax (516) 765-1823 MARRIAGE OFFICER ' �y� �•1 Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER ==7® 1� ��- FREEDOM OF INFORMATION OFFICER /°4°' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD RMNOWN ?: D TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DEC ® 7 • DATED: December 7, 1994 BLDG.DEPT. TOWN OF S•UTHOL® Transmitted herewith is a copy of application No. 1306 for a Cesspool/ Septic Tank Construction Permit submitted by: Samuels & Steelman Architects for Fred and Mary Richardson • 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 /�e Comments: yle,(/---- -P i (re /9 7.714ea a-9;7 Oaf, DEC 9 S gnature fawn Clerk Southold Dated 9 OFFICE OF 'THE TOWN CLERK Town of Southold '4 .'1 � A lication No. �� Judith T. Terry, Town Clerk pp Town Hall, 53095 Main Road �,. vvief4• J Construction P. O. Box 1179 Alteration Southold, New York 11971 Telephone *04 -0° Residential (516) 765-1801 I Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ / C' — DATE �a 6Of APPLICANT NAME: 63402 5' 4 6)FEZ `MTEC7Bf APPLICANT ADDRESS: X036 &Jig/A/ 6C9n,C7 0.6/ CfirOc-UL l 41/ /79 36 SEPTIC 17 CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION a5'EE //c(o CEP c 4/v/90€06/ED kS'/7-E- 0e/51A/ LOCATION MAP: Must be attached hereto before permit may be issued. • LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: re&D 4- IrmAoy 7.7 3-A44e.asO/( OWNER MAILING ADDRESS: PQ2 COX /c?,?/ P/773' /e6jff P,4 /5-0 // OWNER PROPERTY ADDRESS: V' 30 / .D/62A/ /Vcf KSIE04D pb—cOrvi y TELEPHONE NUMBER OF CONTACT PERSON: -/(�J6yatt4.- -e4 i 731/_&zOE TAX MAP NO. : Section Block / Lot CROSS STREET: • BUILDING PERMIT NUMBER CROSS REFERENCE: 4!""'"-- Signatur- - Applicant RECEIVED BY: Town Clef k's Office lDATE: /Z /c� y • • 4 • , • -- ;1, V - . . ' ' - i . ,. - ' , . . . . , , - . - - . . . . „ .,...,•. CTM # " 1000 86 - 7 - 7.3 ' ROPERTY: 7930 Indian Neck Road DDRESS PecQnlc, N.Y. 11958 , . ; , • WNER: Ed and Betsy-Nolan - . . 10 East End Avenue New York, N.Y. 10021 Tel # (212) 439-6056 ' - - ITE: '‘ 1.30 Acres .. . REA - URVEYOR: Rotkeri,ck Van Tuyl Greepport, N.Y. ,11944 . • , License # LS 25626 .'_..` a Dated: 2 / 7 / 80 . _ _ . ._ Amengl�d: 101 16 180 ' OTES: Elevatjont shown are ' V based on Suffolk County Department of Public Works - . 1 ; Aerial Survey. Public Water ' is not vailable-.within 500 ft . of pro erty , . ' The to atIons of wells and V cessp ols shown hereon are . , from f old obfiervations and -, or dat from data obtained from Others. . ,, OEALTH 'I am familiar with the • , , DEPARTMENT stand4rds for approval and -. _ . TATEMENT , constrictioh Of subsurface • , . V sevVagge disppsal systems for . Single family residences and • will abide b the conditions . ' ' ' set forth th rein and on the ' V permit, to c' nstruct." ' IGNED: .. //j i 7c,►� , ✓ 1n r 1 y / giti� Y(1) /1 / , / / . . , / / , / , / ' / r I/ // ,-. ; . !4'NdLE HITAti MELLNG ONLV ' VPIRES THREE YEARS FROM DATE OF APROVAL ia\ SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE FOR AFPROVAI. OF CONSTRUCTION OF SINGLE FAI,,,,in RESIDEI\CE, ONLY DATE NOV 0 3 1991 , -- - , ! s a- --0 • , i., lAPPROV 4 EXPIRES THREE YEARS FROM DATE OF APPROVAL I , ,..... , ......-..6.1. PLEASE NOTE Minimum distance between well and cesspool is to be 150 feet. , \, ( "•••,. I-- ,, .. •. , 1 : • 1 -• I --,, - . -o._.___/--\____ ,----ter Rns-z--.0 ,5A1,1 r•-rA, ,' 1 . 3 . .. • . , I1 - // 1.? .%r;101-..1 1....EAC4-4r PRO PO SEP . , .• • ,,_ I FA,Isit 1....Nr, 1 i -z.2___. , I '--I'l•W1-.1.7e> ,.,...) PLESI Ce.t..jOtt, , Cc i 1 , .' 1-1/-‘41..)0-1--Z-c.14.2.Cvir-4i::, ,------ • 1 , 1 _ ____.---- Is,, •' ,_•• , • ir.. .....j__:--- '-' e..r 1---5--f L P - - • -, • •• • • - .. • • . \ S . I _.- ---_. ____ __ . . 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