HomeMy WebLinkAboutScollard cFFOLiY ®vi
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
tri ,� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V ��� Fax (516) 765-1823
MARRIAGE OFFICER � ®/�1 Fax
(516) 765-1801
RECORDS MANAGEMENT OFFICER = ®1
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. 1079 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : THOMAS C. SAMUELS
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. #93-SO-70.
Name Of Owner SCOLLARD, PATRICK J.
Mailing Address 1 129 STRADFORD AVENUE
City St Zip GARDEN CITY NY 11530
Property Address 1 WILLIS CREEK DRIVE
City St Zip MATTITUCK NY 11952
Tax Map No. section 123.00 block 10 lot 3.000
Cross Street MEADOW BEACH LANE
Building Permit Number Cross Reference:
Issue Date: 12/23/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
��.0 S���0[� ® _ 4 �� lf'
JUDITH T. TERRY :, Ze Town Hall, 53095 Main Road
TOWN CLERK ® It P.O. Box 1179
tJ� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = eY® ,4% Fax (516) 765-1823
MARRIAGE OFFICER (Zr,•� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER '_�®,l el
FREEDOM OF INFORMATION OFFICER '''........,40V.—1 le�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD fi ""�
:'i a.,;„,
PI
TO: Southold Town Building Department 1-1j �� 0 51993
LL
FROM: Linda J. Cooper, Southold Town Clerk's Office
.1.,,2:01A .-,,'r,_
DATED: December 14, 1993 =3
Transmitted herewith is a copy of application No. 1114 for a Cesspool/
Septic Tank Construction Permit submitted by:
Thomas Samuels for Patrick J. Scollard .
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
Comments: g.fT• 90 r Z.a -7
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two g.2 1093 Signature
tymr, Mg SOWS Dated
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' OFFICE OF THE TOWN CLERK cIFD(,( ,
Town of Southold (71 Application No.a //((
Judith T. Terry, Town "Clerk
Town Hall, 53095 Main Road Construction
P. 0. Box 1179 �PI'�'' �� •x.•
Southold, New York 11971 ® 3 Alteration
Telephone 01 tOI� 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 Peeet,4 'r / J 3
APPLICANT NAME: Wto nad° C. So.144 -ve,td
APPLICANT ADDRESS: 025a36 Maim Reed
Cateit rt e,, .*:y. Ail;3S
SEPTIC /CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/Veal s'a f4 tom, 749P new oa'h.e / n,j t e-
op ed. A o aCu a tme :
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Pa y?/* 4T U `.
OWNER MAILING ADDRESS: `2 ' till ev/
OWNER PROPERTY ADDRESS: /0/7/Z4 Pee.* jL iLre;
/Yl a-r6i'vijc , A/7 //9,5--
TELEPHONE
/9 TELEPHONE NUMBER OF CONTACT PERSON: 7F741
1
TAX MAP NO. : Section J Block /® Lot 03
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applicant
RECEIVED BY:
REMO
prelTo n Clerk's Office
DATE:
SCTM # 1000-t 23-10-3
r40RCPEF Y: 905 Willis Creek Drive .W u 2 ul75
' ADDRESS . Mattituck, N.Y. 11952 . . w _ -
Qr+ U �
. - ' ' w ••
moi,• "o
OWNER: Patrick Scollard u
129 Stafford Avenue < !--- • U 1.
Garden City, N.Y. 11530N .
EXISTING : Agricultural-Conservation (A-C) - " t
ZONING
SITE: 1.0472 acres 3_
.AREA *
SURVEYOR: Peconic Surveyors, P.C. . . '4�� ;P�:� •.-;
Southold, N.Y. 11971 . °, o0 , -
Ak
License # LS 49618 "°
Dated: February-16, 1990 r'� t �o _'
NOTES: -Elevations shov'n are based on National '.y� • '� • ��� •
Geodetic Vertica Datum.of 1929. _ . . .— ,
ID/�/q
--Public water is available to the site Project No:':93-r 3
'^ 4' -The locations of wells and cesspools
shownhereon are from field observations Drawn By: U TA-b =:.
end or from data obtained from others.
Checked By: 'TS` -,
HEALTH "I am familiar with the standardsDate: rQ/ l��!3
DEPT. . for approval and construction of .
STATEMENT. subsurface sewage disposal systems Scaler. t N •.---2.0,1;_c,":- -
for single family residences and , - -
will abide by the conditions setSheet Title:' ,
forth therein and on the permit to _
construct. On - SITE ' '
.SIGNED: � 1.f . _v mss. .zPLAN.
Patrick Scollard ' & .SITE _
. DETAILS-' - -
u.
NCY DEPIGt F
FOR APPROUAt.Cl: CDdt4" :�°� 101d�F . . ,
SINGLE FAMILY F5106t0 �j O �� Sheet No:, -
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