HomeMy WebLinkAboutSchlegel Town Hall, 53095 Main Road
P.O. Box 1179
psla$' • Southold, New York 11971
i����� FAX(516)765-1823
JUDITH T.TERRY
TOWN CLERK TELEPHONE(516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 499 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SCHLEGEL
Address 1 : 75 BIRCH HILL ROAD
City St Zip MT. SINAI NY 11766
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.
Name Of Owner SCHLEGEL, LEONARD AND DONNA
Mailing Address 1 75 BIRCH HILL ROAD
City St Zip MT. SINAI NY 11766
Property Address 1 EAST SIDE AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 99.00 block 3 lot 15.001
Cross Street BAILIE BEACH ROAD
Building Permit Number Cross Reference:
Issue Date: 6/06/89 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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in
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® �t._;; °^�:{ `r�,,� Town Hall, 53
095 Main Road
11-t::477141111:1:1'1.-
ria°^`'` * 1179
� "�� � _ � �+� P.O. Box
T•Ovviv " `�' �. �4is ���� Southold, New York 11971
JUDITH T.TERRY �°""�'""�• `-`' .�,- ��..„„00, TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: May 30, 1989
Transmitted herewith is a copy of application No. 511 for .a Cesspool/
Septic Tank Construction Permit submitted by:
Leonard and Donna Schlegel
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 X
DISAPPROVE
Comments: ate, .4..„ a.,, oh fait vara Jir (Irak
)-\' 2‘.k.' 11
N c Zo . $43LAL2- Le •
\Coz.5f CD,L Q.t.S2.....,
Signature
Lo/6,/$ T
Dated
OFFICE OF THE TOWN CLERK PFFD
5c
Town of Southold2,-•.) -•`' ""• : �
Judith T. Terry, Town Clerk 4.� .,,_^'' Application No. ���
Town Hall, 53095 Main Road Pm_ Construction
P. O. Box 1179 cry �• �Q '� r',,';:.44. .
? • Alteration
Southold, New York 11971 ;...
Ol ��0
Telephone [ Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 3U7_16)1
APPLICANT NAME: / Q/1( TC/ SCA /4201e_,
APPLICANT
AN
C T ADDRESS: ��y�� ��� �,(� �8
H7'- 5?, ncu'> I. (17C C
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION (10ectatc/
±LOCAAao bhp. -I 9 dwe/!ii a tic(( '- 4--/-
LOCATION
TION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATI
OWNER OF PROPERTY: Li 0)-10uca �C1(1 1P • Ac 7_, "4/4_, -A,/67 ,,.
.....42
OWNER MAILING ADDRESS: 4 �" /4/` c 5 ;'
tr C
OWNER PROPERTY ADDRESS: f5 / S -4? 9V.-.
/ik ff'7 Ld -
TELEPHONE NUMBER OF CONTACT PERSON: 9'2d/-760
TAX MAP NO. : Section 97 Block J Lot ,%S I .
CROSS STREET:___ ,�11je. e �/+ ed
BUILDING PERMIT NUMBER CROSS REFERENCE:_
• p .1 • . i /
Signature of Applic. t •
RECEIVED BY: :CU `
own Clerk's rt -'7're
DATE:__________________________
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�,�; ; VACAVT� dt iit,, '. o�.c I
PLEASENOI d� TEST HOLE ,
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r P-111162,-1-15P Ci 'ATii F.F.=l_. 05'
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y.,i.421111-_5 J: { EL-1 E!-`;A.5s esowN
cover
^'- grade,
r1 .�1 �, —:Ts� --7�:.::---- �; —' CLAYEY
coot I to `.fade, __ "'` SAND II 0'
I E.�ILY.. ------'— -- ` 3 -- I.E.:-2 5 MEDIUM
18 AILS 70 COARS
i . ITV h,F c-1DE:• - 900 DIAL SAND
'' 1•.1r_-;t ` !- L Lill '( v' - ASL
i"•,•.,•'1. A �Epr rArl
-.1"3--r. -c 'tr,,r,) -: , -,',j !'.,i':1 ( ,`", !:. �:I- ,-i,'1G:E{2 7r4941.. !70'
1. .. L_.7 I o •• v !
NOTE: ToPO 941'4 F2 7/-t 5 1'9 &/til4' 7 'p'9 (u�E(�� Ppp(. 7htEM� e r
ELEVATIONS ARE REFERENCED TO M.S.L.DATUM
SURI/EY FOR
•
LEONARD C. SCHLEGEL 8 DONNA M. SCHLEGEL
.nirrOLK COUNTY DEPARTMENT Or ? jrtAN SERVIC@0 MA R.13,1989
J AN.H, 1989
- AT Ms-i1TITUCK DATE MAY 7,1986
•
FOR APPROVAL OF CONSTRUCTION ONLY Towm cyb: SOUTHOLD SCALE: I" = 100'
• DA ' t _ISS RFS. NO. a �''' `' I I SUFFOLK is C�f� I TY9 NEVI YORK _ NO. 86-430
. `'}
I. -----==---- N UNAUTHORIZED ALTERATION OR ADDITION TO MIS GUARANTEED TO:
� • % SURVEY IS A VIOLATION OF SECTION T200 OF THE
fr 7K'PQ()VED ''(_' f p�/.-�/rf,,?-;f NEW YORK STATE EDUCATION LAW CHICAGO T"1 -.i 'OE COMPANY
N COPIES OF TMS SURVEY NOT EZARS-IG THE LAND ,' i1X1 141(14.4%, ' 1
SURVEYOR'S IRKED SEAL OR EMBOSSED SEAL SHALLb 'e,
NOT BE CONSIDERED TO SE A VALID TRUE COPY ,/' DAD 41 0P'..,
NGUAIRANTEES INOICAT;'D HEREON SHALL RUN ONLY .) 1 /" t
HEALTH DEPAkf14ENT DATA FOR APPROVAL TO CCNSTr�UCT THE aEz�ov FOR WHOM THE SUP/EY Is PREPARED ; O ®g,
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVER i-
N NEAREST!WATER ESAIII_MI ; 1,6 SOURCE OF WATER, P'RNATE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED I ,
N SUFE CO TAX Wa' DST 1000 SECTION 099_ LOCK_;_LOT IEF.I HEREON,AND TO THE ASSIGNEES OF TI-!E LENDIP:S ' hK+'�•
N THERE ARE DWELLIPrSS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION OUARANTE2S ARE NOT TRANSFERABLE ?; '`
OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT +'tr,, ,
N THE WATER SUF,'LY AI,'D SCVA10E DISPOSAL SYSTEM FOR THIS RESIDENCE
•OWNERS - 1
WILL CONFORW TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT ,i DISTANCES SHOWN HEREON TROP! PROPERTY LIKE'S %'.
OF HEALTH SERVICE'S. TO Exl$TI➢JG STRUCTURES ARE FOR A SPECIFIC
"$'y
APPLICA.VT� f PUR?OSE A,iYb APE NOT TO BE USED TO ESTdELISIi /&
�I .e,<.^,-cad P •
PROPERT•, LINES OR FON THE ERECTION OF FENCES f ,4;�''''•,,-4/111).SU"' `
e once Sc.h I P -,� ,� ,
ADDRESS 75 r3+,rct (J .(l red kt 3 i 4.,f 1 , 1 _ i
Noo y<<,-K //166 TEL.s76 VZ67-4/766 YOUNGYOUNG �NEAVENUE
NOTE: n=MONUMENT 0= 4"x4` POST "`'1.:'`.'A ��'`
RE; LOT NUMBERS,EAST SIDE AVENUE a NORTH LAGOON LANE `A. ,. ALDER Wr. .YOUNG,PROFESSIONAL ENGINEER ,
" ,r *,,,„1-"• *' s AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
ARE SHOWN ON SUBDIVISION MAP OF OLD MILL HAVEN�. FILED '
• IN THE SUFF. CO.CLERKS OFFICE ON OCT.2,I925ASFILENO.799 C HOWARD W.YOUNG, LAND SURVEYOR
*THE LOCATION CF IPt1,L(!Y),SEPTIC TAIIX(ST)IDCESS9.00LS(CPT SHOWN HEREON r `;Z N.Y.S.LICENSE N0.45893
ARE FROMFIELD 0+92RWTIONS AND OR DATA OBTAINED FI 0Id •OTHERS •
,
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BRANDIS E. $01,5 P•C. 1046 . - nnr� onax�am
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• r SIJI-I�O11;. a.UN SY DEPARTMENT Or t-,, S I
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F�;;; APPROV,AL OF CONSTRUCTION OF `
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