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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK r\ _ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �! Southold, New York 11971
MARRIAGE OFFICER Q {1` Fax (516) 765 1823
k ! 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. 679 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GEORGE PONTINO
Address 1 : STILLWATER AVENUE
City St Zip CUTCHOGUE NY 11935
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 1/91 .
Name Of Owner MOLCHAN, ROBERT
Mailing Address 1 RUTH ROAD
City St Zip MATTITUCK NY 11952
Property Address 1 2600 RUTH ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 1 lot 3.000
Cross Street SUNSET DRIVE
Building Permit Number Cross Reference:
Issue Date: 1/28/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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9J
1 JAN 221991 : !
i Town Hall, 53095 Main Road
BLDG. DEPT. m � P.O. Box 1179
TOWN OF SOUTHOLD
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iyrig Southold, New York 11971
JUDITH T.TERRY - r,;:�-" 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: January 22, 1991
Transmitted herewith is a copy of application No. 698 for a Cesspool/
Septic Tank Construction Permit submitted by:
George Pontino for Robert Molchan
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: C .® � c ,:. '1' kcal. `r-'t�
1 t
0.411
Signature
Dated
OFFICE OF THE TOWN CLERK OcwFFUL f;
Town of Southold , Off, ` G
Judith T. Terry, Town Clerk ��' Application No. 6
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Town Hall, 53095 Main Road o u ;t• �-
CJ7 ` Construction
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P. O. Box 1179 ".
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Southold, New York 11971 �•• Alteration
Telephone "01 xlt N►) 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 TOt,11
APPLICANT NAME: ; ea Y o747/X..0)
APPLICANT ADDRESS: CE=
SEPTIC CESSPOOL ,C
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
NQ W Ha ks e_,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF-PROPERTY: ` cr } -T focr-Lr' 4q1,1 ,g
OWNER MAILING ADDRESS: '-)16,
OWNER PROPERTY ADDRESS: A 6 o- c,
m ct
TELEPHONE NUMBER OF CONTACT PERSON: r -- Z p 7 5—
TAX MAP NO. : Section I b66 Block I Lot
CROSS STREET: - sC, 1/4..` kri•,
BUILDING PERMIT NUMBER CROSS REFERENCE:_
Si ature of Applicant
RECEIVED BY:
Town Clerk's Office
DATE:
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SURVEY FOR
N1TY DEPAkIMEN1 OF hEALTh SERVICES ROBERT MOLCHAN
AT MATTITUCKJAN s ,195
3ROVAL OF CONSTRUCTION ONLY DATE DEC.24,195
TOWN OF SOUTHOLD ,
_ SCALE I"=60.
�' / S�% _ � SUFFOLK COUNTY, NEW YORK No
7 REF. NO_ // 90-0996
$UNAUTHORIZED ALTERATION OA ADDITION
—��j / TO THIS
'-' ''''''` �����AI SURVEY E A VIOLATION OF SECTION 7209 OF THE
/ -NEW YORK STATE EDUCATION LAN'
$COPIES OF THIS SURVEY NOT
7 \ BEARING THE LAND ,�,
y`� /^ /,1-, SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL
NOT SE CONSIDERED TO BE A VALID^ TRUE COPY c,'‘ '.
}
THE PERSON FOR WHOMEOHEREON THE SURVEY ISLRUN PREPARED W k OILHENT DATA FOR APPli0W4AL TO CONSTRUCTAND CM MIS BEHALF TO THE TITLE COMPANY, GOVERARED -RAIN_MI _' NSOURCE OF WATER PRIVATE_PUBLIC MENTAL AGENCY AND LENDING INSTITUTION LISTED OZ0
• DIST 1000 SECTION 106 BLOCK _I LOT g/n z HEREON, AND TO THE ASSIGNEES OF THE LENDING } s
OWELLINOS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE l"
E SHOWN HEREON
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
1�.-�:Yv;
_Y AID SEIIAGE DISPOSAL SYSTEM FOR THIS RESIDENCE OWNERS -�,`/„�-
THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES
ES TO EXISTING 3TRUC TURES ARE FOR A SPECIFIC
�` p�y"� PURPOSE AND ARE NOT TO BE USED TO ESTABLISH ��CF 45' �
li c / / AL PROPERTY LINES OR FOR THE ERECTION OF FENCES 'QA. %
G /4 /1 1PC e).--e&Y 7 F�44/ID SUS/
1
E� / // IL ,2? 9F �z YOUNG YOUNG R TRANNEEWt,
A &STAKE O-PIPET _
VOR SUBDIVISION FOR WILLIAM MOLCHAN a { ` ALDEN W YOUNG,PROFESSIONAL ENGINEER
1 y AND LAND SURVEYOR N Y.S UCENSE NO 12845