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JUDITH T. TERRY Town Hall, 53095 Main Road
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TOWN CLERK z ® Fri P.O. Box 1179
REGISTRAR OF VITAL STATISTICSOF5 � Southold, New York 11971
MARRIAGE OFFICER O
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116 ���' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 947 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : MODERN REVIVAL CONSTRUCTION
Address 1 : JOSEPH E. MALAVE
City St Zip CORAM NY 11727
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 ON 12/2/92.
Name Of Owner MALAVE, JOSEPH AND AMY
Mailing Address 1 P. O. BOX 314
City St Zip CORAM NY 11727
Property Address 1 WHITE EAGLE DRIVE
City St Zip LAUREL NY 11948
Tax Map No. section 127.00 block 9 lot 27.000
Cross Street WOODSIDE LANE
Building Permit Number Cross Reference:
Issue Date: 12/22/92 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY ::' A Town Hall, 53095 Main Road
� `% P.O. Box 1179
TOWN CLERK 4, Southold, New York 11971
REGISTRAR OF VITAL STATISTICS L
MARRIAGE OFFICER ® � Fax (516) 765-1823
�� �4.! Telephone (516) 765-1801
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OFFICE
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OFFICE OF THE TOWN CLERK b .,..,......._-_,.-1 i
TOWN OF SOUTHOLD k�fti;`:. �
1 DEC D D B h
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TO: Southold Town Building Department A t_ G• 4JEPT.
TOWN N Ell;SOUTHOLD
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: December 11, 1992
Transmitted herewith is a copy of application No. 974 for a Cesspool/
Septic Tank Construction Permit submitted by:
Joseph E. Malave/Modern Revival Const. for JOsephi and Amy Malave
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.
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Thank you.
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
•
and make the following recommendations:
APPROVE K -
DISAPPROVE
Comments: 4,3 oL4..e.. L 0.,, ;;, zmitlAtirfifx.c.h.,4,
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Signature
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town ad
Dated
OFFICE OF THE TOWN CLERK c.gFO/ f:
Town of Southold
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Judith T. Terry, Town Clerk Application No. 9/
Town Hall, '3095 Main Road ors; _
Construction
P. .0. Box 1179
wt�( �`
Southold, New York 11971 - r Alteration
Telephone X01 r �� � 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 \ p ..6
APPLICANT NAME:
APPLICANT ADDRESS: (4:3L9
SEPTIC CESSPOOL .
d DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
111,
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: __A 4- 1.
OWNER MAILING ADDRESS:
•
OWNER PROPERTY ADDRESS: W
TELEPHONE NUMBER OF CONTACT, PERSON: (57 ; 624—
TAX
2 —TAX MAP NO. : Section i,"7.„—/ Block 9 Lot
CROSS STREET: (�85 ! �pf`� � Woc,c3i, „Le
BUILDING PERMIT NUMBER CROSS REFERENCE:
I ,
• iAlie •Signature of Applicant
RECEIVED BY: 11 /
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vn Clerk's Office
DATE: / 21.4
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IS
SINGLE FAMILY nwELLING ONLY NOV 1S1592
EXPIRES 3 YEARS FROM DATEOFAPPROVAL SC.DEPT CF
• HEALTH KR I„=3
SURVEY FOR
,UFFOLK COUNTY DEPARTMENT OF HEALTH SERVICE, JOSEPH MALAVE a AMY-SUE MALAVE
LOT 27, "GOLDEN VIEW ESTATES" SEPT 30,1992
FOR APPROVAL OF CONSTRUCTION ONLY AT LAUREL DATE MAY 19,1992
2'nnZ _ `ID� TOWN OF SOUTHOLD SCALE I" = 50'
DATED..—0 HS REF. No. 7- SUFFOLK COUNTY, NEW YORK NO 92- 0395
n N UNAUTHORIZED ALTERATION OR ADDITION TO THIS CERTIFIED TO
// �, SURVEY BI A VIOLATION OF SECTION 7205 OF THE JOSEPH MAL,�Ap
.Poor,vFO NEW YORK STATE EDUCATION LAW AMY-SUE,MAT2ANM,
, r COPIES OF THIS SURVEY NOT BEARING THE LAND FIRST�.AM£RI ''�Q/l SURANCE
SOT VEY OINKED SEAL OR EMBOSSEDIDSEAL SHALL CO Afla �
NOT N CONSIDEREDNDICTO TEA VALID SHALLNEON TRUE COPT t' �V-F
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE HE PERCN SON
EFORAWHOM
THE OTHEET ULE COMPANY,IS PREPARED
REPGRuN o u LT N `y£��`y r .{TO✓tip O�
_ MENTAL AGENCY AND LENDING INSTITUTION LISTED r / �'D X
R NEAREST WATER MAIN_MI ' N SOURCE OF WATER PRIVATE PUBLIC__ j A'�%`��A
M GUFF CO TAO NAP DIST ENS_SECTION 12T NOCK 09 LUT 1.L HEREON,AND TO THE ASSIGNEES OF THE LENDING i I n���
*THERE ARE MO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE b- V /
OTHER THAN THOSE SHOWN HEREON TO ADOITIONAL INSTITUTIONS OR SUBSEQUENT T....;,1%1 (Vttc;fn�
OWNERS .( '.;Y
M THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM MAI THIS ROI DENIM I^y 0 ,�56' .*"4-.,
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT
*DISTANCES SHOWN HEREON FROM PROPERTYSPECIFIC LINES / Pi.,''
OF HEALTH SERVICES TO EXISTING STRUCTURES ARE FOR A 1I..�� I.
PURPOSE AND ARE NOT TO BE USED TO ESTABLISH TT,7VD�Li�:l
APPLICSHT•F 40 22c-V iv4,1_, C-.. C'.t v_clui
PROPERTY LINES OR FOR THE ERECTION CF FENCESoerl•.
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ADDRESS--
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OSTFtANDER
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NOTE A=STAKE
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK ALDEN W YOUNG,PROFESSIONAL ENGINEER
OF SUFFOLK COUNTY ON AUG 30,1984 AS FILE N0 7770 AND LAND SURVEYOR N Y.S LICENSE NO 12845
HOWARD W YOUNG, LAND SURVEYOR
*THE LOGTDM OF WELL(W),SEPTIC TANK(ST)S CESSPOOLS(0)SHOWN MENEON NYS LICENSE NO 45893
ARE FROM FIELD OMSERANTIONS AMC OR DATA OETANNED FROM OTHERS ,.]P
BRANOIS A SONS INC.5046