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JUDITH T. TERRY � ,,. '�°. � Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t`e , � Southold, New York 11971
��" Fax (516) 765-1823
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MARRIAGE OFFICER ® t,.t v v �
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14/ ' 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. 1044 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X •
PERMIT ISSUED TO:
Name : STRUCTURAL TECHNOLOGY INC.
Address 1 : P. O. BOX 378
City St Zip SHIRLEY NY 11967
. Descripton of Proposed Construction or Alteration
SEPTIC SYSTEM FOR SINGLE FAMILY RESIDENCE.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES REF. NO.93-SO-58
Name Of Owner MADISON, GEORGE
Mailing Address 1 201-209 PARK AVENUE
City St Zip ALBANY NY, 12244
Property Address 1 DUCK POND ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 83.00 block 4 lot 3.000
Cross Street OL I V I A LANE
Building Permit Number Cross Reference: 21664
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Issue Date: 9/24/93 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY . Town Hall, 53095 Main Road
TOWN CLERK t ® rP.O. Box 1179
REGISTRAR OF VITAL STATISTICS - :ErbW ` Southold, New York 11971
MARRIAGE OFFICER :. V ��, Fax (516) 765-1823
___ i iii � ••• Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
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TOWN OF SOUTHOLD SEP h 1 '� Ig '
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f31124 . DEPT —I- i1
TO: Southold Town Building Department
T (W SOJT OLD
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 8, 1993
Transmitted herewith is a copy of application No. 1075 for a Cesspool/
Septic Tank Construction Permit submitted by:
Structural Technology Inc. .
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 .,.
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* * * * * * * * * * * -*
I have reviewed the application and location map of the project cited: above
and make the following re mmendations: .
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APPROVE - ..
-, DISAPPROVE
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Comments. 7p;." /!/ dize-e-off
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Signature W
Dated
7/21..3/9 3
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OFFICE OF THE TOWN CLERK �\;rfD
Town of Southold �,0 J. ` ��✓,,
Judith T. Terry, Town Clerk :'•'' 7s
rw�" y Application No. 1a
Town Hall, 53095 Main Road
P. O. Box 1179 u' x': Ft. ,n fi Construction
Southold, New York 11971 O.' `r
-r� 0 Alteration
Telephone "01 i`fe �b--f� Residential t�
(516) 765- 1301 . • ,j�fl
Non-Residential tial
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
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APPLICATION
•
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for
CONSTRUCTION or ALTERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
d
DATE r 2 3
APPLICANT NAME: 54 (
APPLICANT ADDRESS: /0 % L1ria ,I1 ed. /® � -a
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SEPTIC,' CESSPOOL
DESCRIPTIO•
N OF PROPOSED CONSTRUCTION OR ALTERATION ` __i ,/ r;f
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 6-004 6 ',6
OWNER MAILING ADDRESS:2�I ® �j 60,
• /j 6,471/ /V ' Z
OWNER PROPERTY ADDRESS: t
4A(.6 fi ' : / . • .
TELEPHONE NUMBER OF CONTACT. PERSON: 2,7/-
Foci •
TAX MAP NO. : Section Blocl<
Lot a3
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CROSS STREET: 04.%4 , 4_ RA/ e- ._.__________ •
BUILDING PERMIT NUMBER CROSS REFERENCE:_
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f • Signature of Applicant
RECEIVED BY: , - (.1(-1/44--,,___L--
g -�o vn Clerk's Office
DATE: .
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NOTE:
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THE CONTRACTOR IS RESPOSIBLE FOR
OL / 1//A LANE CHECKING ALL DIMENSIONS SHOWN StRl1CTURAlTECHNOLOGY,INC.
BEFORE PROCEEDING WITH WORK. ANY 1029 Wino Floyd Pkwy.
DISCREPANCIES NOTED SHALL BE BROUGHT P.O.Box 378
TO THE SURVEYORS ATTENTION Shirley,N.Y.11967
• IMMEDIATELY. 516.281.4800
TAX DISTRICT /000 TAX SECTION 83 GRADES TO ASSUMer) DATUM _ SURVEYED ✓l/n/B //, 1993
TAX BLOCK 0¢ 03 ROADS MAINTAINED BY. TOWN LOCATION SURVEY ION FNDI �••�li{t((!U/// ,
BLOCK LOT LOTSFINAL SURVEY ���wC`o`.N�ir/
! MAP OF k/000B/AJE M/1`ti/�R GUARANTEED TO STieUG TU�PifL Te-CfiA/OL06Sf J} o:,. E•t•DA.�i'•r0
L AM CR/C Aa T,TLC /A/5. CO. �, `, c OO
JEROME D'AMARO f/ •+ ,• :Q •y'•P
i PROFESSIONAL ENGINE '&LAND SURVEYORS CO `%>ti k (� Vitt~
N VS LIC NO PEL 037209 6 LS 049684 - /P :1 6 ; o
FILED MAP NO 8239 FILED OECEMSER A.S /Seg ... t
r SITUATED AT TOW", OF J'O r/Tf/QLO,Sr/FFPLK Cot•6tITY,NY - 800 SUNRISE HIGHWAY IYo �a� ��.%
a,_ r WEST BABYLON,N Y 11704 ,s :6 L1 tiit24-4?.. q;
SCALE / 30 TITLE NO DRAWN BY N/y,1 CHECKED BY. (518)321 4488 SURVEY NO S930490 i� +93Z N9;... :��Q
` LJneYthorised 91190 tion]or addition to this survey u a violation of section 7208 of the New York State Education Law Copies of this survey map not bearing the land surveyor's inked seal or embossed seal shall not be considered to be a valid copy Guaru or Certifications
tions indicated
pot ENG111LE`\\\`���
hureOn shall run only to the person for whom Ni.survey,s prepared.and on his behalf tO the title company.governmental agency and lending institution listed hereo •end to the assignees of the lending institution Guarantees or certifications are not trensfersble to additional institutions !lg111111111
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or subsequent owners -Offsets are not to be used to establish property lines
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