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JUDITH T. TERRY Town Hall, 53095 Main Road
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� P.O. Box 1179
TOWN CLERK �'
REGISTRAR OF VITAL STATISTICS I" ih : Southold, New York 11971
MARRIAGE OFFICER `. ' , � � Fax (516) 765 1823
®� V1� Telephone (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 735 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ROWLAND HOMES, INC.
Address 1 : 266 LAKE AVENUE SOUTH
City St Zip NESCONSET NY 11767
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 6/27/91 .
Name Of Owner SCHENONE, WILLIAM AND MARIA
Mailing Address 1 53-63 69TH STREET
City St Zip MASPETH NY 0000
Property Address 1 WESTPHALIA ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 7 lot 11 .003
Cross Street YOUNGS AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/24/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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s. I '•r � •..-:';` `7.27.4 ' " .r Town Hall, 53095 Main Road
�: .- .r P.O. Box 1179
:,.. • '; ; Southold, New York 11971
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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
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: July 3, 1991
Transmitted herewith is a copy of application No. 754 for a Cesspool/
Septic Tank Construction Permit submitted by:
Rowland Homes, Inc. for William and Maria Schenone
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.
, 5-7--01----9. a0--070,/
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above .
and make the following recommendations:
APPROVE pr
DISAPPROVE
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OFFICE` OF THE TOWN CLERK 4116-r C'
Town of Southold sJf=r �G
. ::. �r Application Judith T. Terry, Town Clerk �� �T �. . pp 'cation No. 7Sk7
Town Hall, 53095 Main Roadcan I T, 43/4' .�'•:: Construction L.--
P.
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone 0I r s Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for,
CONSTRUCTIONor ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. •
Fee $762--c.� •
DATE �'v Lr - ( /
APPLICANT NAME: Ace..114-AZ awes
APPLICANT ADDRESS: 6 CA-t 4 U? SC
• )J ca-i - , ,,v(j I/ 7 6 7
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION. /
1' / 7
p.�riYlc�
Ni LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Lb►iiiaky) CL1-Q`Ca
OWNER MAILING ADDRESS: 53 -(03 6o9 14'' Et- Spit-1 MIt_ -
OWNER PROPERTY ADDRESS: 1,0 est
Maid .irk h 1
TELEPHONE NUMBER OF CONTACT PERSON: 51&, 1(00--
TAX
(00 ..TAX MAP NO. : Section / 14- Block 7 Lot //- 3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:.
Signature of Applicant
RECEIVED BY: A}° C c
Town lerk's Office
•
DATE: 7u} l/
.•.AUIHVIOLLU 41.1L.AlPJn V.AWIIINR.
r0 THIS SURVEY IS A VIOLATION OI 1
SECTION 7 209 OF TM MW YORK STATE SUFFOLK COUNTY DEPARTPL�CPJT OF HEALTH SERVICESLCI _ .., •.
'DUCATION LAW v:
COPIES OF THIS Suevr,MAP NOT BLARING EOR APPROVAL OF CONSTRUCTION OF ( \ \ �� ,�
ME UNp 7UPV!•PP 5 INKED AAL OR �V `
.YYOSSID SLAT SHALL NVT DI CO••:IDEREC Single Family Re sidence OIII ` \ `
ND BE A VALID TPUL COPY 1 1 /y� SO ^�0I S S
)UAPANTELS INDICAND H.RLO,SH+rI tun ��l2 •_,,.Jl��'s'S �F' NO. --=� - <�y I \` Y\ ss G
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"AY TO THE Pt LSJN FOR WHOM(H.it.R V! a ` `A 'L.i` 1 I 1, ` ` / °
S IRt:AKEJ,ANL,ON HIS IXHAIF Ill 11-or APPROVED ER _l 11"1""E .,
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'ITU COMPANI,GC'VtGNMC+II AI At,,•I,•AM Ir t/ .1 / / f\ ,f ,/1 •—l/ ••
,NOILIG INSIITUIIL'n LISTED HtRFU+ AND EXPIRES TWO YEARS FR •A DA E OF APPROVAL ov+ , V �/IV� `• -'V - - \°o ,x%`� `�� `z' 4i0y<, v.,..,..1..
' O THE ASSIGNTIi OF THE LENDING INiil =r.wnml�nYBCY.. <\ b ( p�pNt D�1 1 ,�0/ c O{'�'f to -
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,�•IOV GUARANTEES ACI NOL Tiw N]FFRAC.I �.......�.•wn.n.nl . d° �!E _-1L"< `6 \,• \ \ 65 •S.*
_ _ ,DDNIO.,., n.,,III... PLEASE NOTA Y` 58g I 4
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• Sanitary system is not to be f -. .,, 1 \
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o� OA FACAVAT WILLIAM M. SCHENONE 8�
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it 92 9O' , .
,3 AT MATTITUCK _
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NOTE: O ss90 3? ?\ °\620 4' Css4.,'•.m, T.';,, LAIp 10 0' SUFFOLK COUNTY, N. 4 , p
i. `s2 A. S 6 Irh" a' de vlue ik*.i. *
2. =STAKE ENT 9O r1 TO CoAr5e
3. SUFFOLK COUNTY TAX MAP "10, 'j(Jj✓ •,../(:� � SAMV . �/ 4Po 45893
DIST.1000 SECT. 114 BLK.7 LOT 11.3 -t� b• I!s'Orom a,YNArer AC.,AA�
4.ELEVATIONS ARE REFERENCED TO 199J rr plue APR 22,1991 / Scc a
DATE: FEB,14,1991 YOUNG 8 YO•G AND$1301'+o
N.G.V.D. (MSL 1929). - �O To cFaitr
- f$,A D� AMMO SCALE In.60' 400 OSTRANDER AV • , RHEAD,N.Y.
L.jj�r IT O, N0. 91-0066 ALDEN W.YOUNG,N.Y.S.P.E.8 L.S.LIC.NO.12845
SCFr�F HOWARD W.YOUNG,N.Y.S.L.S.LIC.NO.45693
THOMAS C.WOLPERT.N.Y.S.P.E.LIC.NO.61483
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