HomeMy WebLinkAboutRosenberg (3) •
OFFICE OF THE TOWN CLERK c0FE1Lk
Town of Southold �� cG
Judith T. Terry, Town Clerk \� r'
Town Hall, 53095 Main Road
P. O. Box 1179 .cnr , z4 a tTizz41V 'c :
Southold, New York 11971 O _
Telephone �1
(516) 765-1801
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 003 Residential X
Fee $ 10. 00 Non-Residential
Septic Cesspool X
PERMIT ISSUED TO:
NAME: David Rosenberg
ADDRESS: 26 N. Morris
Farmingville, Ny 11738
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
, New system
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: David Rosenberg
OWNER MAILING ADDRESS: 26 N. Morris
Farmingville, NY 11738
OWNER PROPERTY ADDRESS: 880 W. Mill Road
Mattituck, NY 11952
TAX MAP NO. : Section 106 Block 9 Lot 13
CROSS STREET: Jacksons Landing
BUILDING PERMIT NUMBER CROSS REFERENCE: 15100
Juth T. Terr ~`
Southold Town Clerk
DATE : July 24, 1986 1 ''
(TOWN SEAL),
\
,i `
r �• •N�•,,1"'�3i._fiM•'�-'� may
® - $ Town Hall, 53095 Main Road
.4 P.O. Box 728
ita 14
,°ittt Southold, New York 11971
JUDITH T TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD -
July 23 , 1986
David Rosenberg
26 N. Morris
Farmingville, New York 11738
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 not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly yours,
Judith T. Terry
Southold Town Clerk
Enclosures (3)
JTT/Ijc
CONSTRUCTION X
ALTERATION cr3
RESIDENTIAL .X / *
NON-RESIDENTIAL
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
6a
Fee $ /6 oy
DATE `7Z / ow J c 06
l
APPLICANT NAME: RLf/oD ?scRe -
APPLICANT ADDRESS: 0?('‘, /v , / 2OJ egg
Fnie_7MX-5-0 4) , AJV // 733
SEPTIC CESSPOOL '-�
DESCRI TION OF PROPOSED CONSTRUCTION or ALTERATION:
E-110
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU ION or ALTERATION:
OWNER NAME:
OWNER ADDRESS: 02C', A, i1&eie45 g;20 40. 7rn,// ,Pd, m677/t- CJC
TAX MAP NO. : Section tO (p Block Lot /3
CROSS STREET: \j/9c-K5 0/0 r/9-4-)1111-2
BUILDING PERMIT NO. CROSS REFERENCE: /5706
laj P-1
Signature of Applicant
RECEIVED BY: ee_c_
Town erk's ffice 4(
DATE:
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES - ' gg_
I FOR APPROVAL OF CONSTRUCTION ONLY
tIN___ ,
DATE 1 U- 12- I
REF. NO � :x _..
1.
+ IP 110' ,*` ;S.A. >.' ••'!hy•.i`-�4, - ii
Ij .
'_ 410 {, i19 - '•.. _• --,--.`.-... '-r .� jamLP}
ii '.1 �� 3`U Vii- " 'Eit
- -'•-
I
(1-- \;
l ,------N
•
c '
:.-Ti. t ..
iii X68 r 0 0 -,
u�
/ ��} rr�
-7 si „ I t, ff
�' \ ' N.BB 34 [� !E. 125,0 --7
J f �� ,' \ G1 i7'= g?( eY '
_-
r-,
rte'
- / i eC BPfL::( ro. . IrNAU•rc.,tu •tr:.r -r.Ot.wnton
i .'s . , V l�`0 1 (fin �n' V) - 10 THIS SlILvFY lS • vtClAT�'W OP
' C) /' " ! -t-'µ1 'V .-y - EcTic 1 ::,°'•Or '✓.t :::0:.:15:11.- \ l• _ L•. E:UCATION L•N'rf' ^ r (_ _ 4 (N ; =O71E5 Or TSIS S'JF � tiT b12Gr! �/ 1. J':` h- c / fYELAIs,w..V:r�
r-,,,,, , - - _ EMBOSSED SEAL SH-,LL MIT I[CasIMI%
I _ U 10 BL A'' UD TFUE l.CPr
�j., �, 6 CO GJARArITEES INC!CATL: Ntr"SCN SNOLL RUM
CCJJ •S 0 PNLT To THE -EF5-).FCK WHOtA TIE S1.VtVF•
5.88034'40"
.88'34,40 \t\1 . 153.00
{S PREPARED, AND O'+HIS 8E,1t,lT TO'PIE
Ulu COMPANY. GOVfFNMLNTAL AGENCY AN'
)ted that since this '---� LENDING INST'TUTION L13 FIEPSON. AMC
)d in an agricultural a r - o TO TM ASSIONSE, NET'F LEIP0 :WI.9 (i7/� yuTION.GUARANIFES ARE NOT TRA�tl•6R•`
lity exists that the $p AnOmoaAt nttrmttwwt Ci r,Rsto'
-
nay contain trace owRs-
C7'�
des and/or nitrates. l •
eMItcs required. - The water supply T:nd sewage lisp ' l -
arc $meft--prinr to system for this residence %rill con -
a
form to the standard of lilt! Suffolk. I ?!�.f?:=CD :SGT_ :o, ! � '
1 ,,nt, i),,,,,,-1,,,,,, trf 11t`:11,'C1 .`7,t•f\it•C9.. f'"-., -•\{_ •r--i'-..f,:.- t r lr , , 1 --r7 1 I