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JUDITH T. TERRY : Town Hall, 53095 Main Road
TOWN CLERK ® ' ryt P.O. Box 1179
tib) $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS = ems® ��' Fax (516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER sj1®1
�1� Telephone (516) 765-1801
_ °� /l
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. 1225 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : MARY D. HOLLAND
Address 1 : P. O. BOX 617
City St Zip NEW SUFFOLK NY 11956
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. #R10-94-41
Name Of Owner O'DEA, PAUL
Mailing Address 1 C/O MARY HOLLAND
P. O. BOX 617
City St Zip NEW SUFFOLK NY 11956
Property Address 1 SHORT ROAD
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 116.00 block 2 lot 9.000
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 10/13/911. Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
•
/02
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK : ® ; rTII P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS V®� ,' Fax (516) 765-1823
MARRIAGE OFFICER ` aq�®���� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER :7®� I�
FREEDOM OF INFORMATION OFFICER �:� �/�00
OFFICE OF THE TOWN CLERK if! 1
TOWN OF SOUTHOLD r
OCT 5
TO: Southold Town Building Department ���� rr`,
FROM: Linda J. Cooper, Southold Town Clerk's Office �0
1 RLDG, pFl,
� OF SOu�fpOLL
DATED: October 4, 1994
Transmitted herewith is a copy of application No. 1270 for a Cesspool/
Septic Tank Construction Permit submitted by:
Mary D. Holland for O'Dea
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 JJ//
Comments: c5-6Z)
•
41.
Signature -
v Dated/c' 6
.-,,,_---
` .S - -
OFFICE Or THE TOWN CLERK c0FQU(
Town of Southold �< $ ..e.g: D
Judith"T. Terry, Town Clerk = .. < Application No. 1AZd
Town Hall, 53095 Main Road ti!:.t t Construction
P. O. Box 1179 °P"'
��,,,. ifs.
Southold, New York 11971 � 0:', Off,' Alteration
Telephone - . •
Residential `�
(516) 765-1801
'Non-Residential
TOWN OF SOUTHOLD -
SOUTHOLD WASTEWATER DISPOSAL DISTFtICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL'
Permit No.
Fee .$
DATE 16 qY
APPLICANT NAME: ne Y 3 • C 1 /(41),
APPLICANT ADDRESS: A 0 , ,..7Qx- 6 / '2
/0 eu) , U7114 (i , /Ay 11 966
SEPTIC,--'---CESSPOOL
DESCRIPTION OF PROPOSED CONSTRU TION OR ALTERATION
• ,_ ��i ...
,
Or
•
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CON RUCTION R ALTERATION:
OWNER OF PROPERTY: ,C.,( - c �f Ck. C/
�-( O CCS �'
OWNER MAILING ADDRESS: ,,c)_ 6 y M
/4,t,J s,, ti) (4 f los--(OWNER PROPERTY ADDRESS: 4 p (p l., 6 C(-
LA-
C�, -tcJa v � , py
TELEPHONE NUMBER OF CONTACT PERS ` : 73 5 ^ ((f33
TAX MAP NO. : Section /16 Block OG-- Lot I' 7
CROSS STREET: /t/p (() 54) Io 4 tgU._
BUILDING PERMIT NUMBER CROSS REFERENCE:
ll.
' i
. 461 ignatu - of Applicant
RECEIVED BY:
(A} -
Town Cle k's Office
DATE: /d / q ( •• y ,
I,.. _._._ . trt.-. rT/ MITI
TEST HOLE - •.; - -
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BR. j OCT 4 , . a ;, f
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PALE NORTH FORKCOUNTRY
ZEP 28 1? !"r � Ps) g - k C AO R E SAND ORT CLUB *`
DATE Pa-can t
7..., BLDG-DEPT
`` TOWN OF SOUTHOLD
Ear n'o 4 � ..,.,,' ... .. .-._ :,aos WATER IN
enn PALE BR, mem 5 89.4270•E. ,
in 911 VMS 01 rr,` or r FINE TO f�a� 153.77'
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SURVEY FOR �4 ,L e:?
MARY D. HOLLAND 'izy
o
��� "'L c>,-
,4 T CUTCHOGUE x' l Prof K, ,,,
TOWN OF SOUTHOLD a Q _ �;',�-,�� a Z6• I�. . - ''';'-r
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, /Fa '.A'.
SUFFOLK COUNTY, NY
fg ' P
1000- 116- 02- 09 �; , o o� c 1
Scale: 1"= 30' o /� °� od. V tz,Apf-il 7, 1994 k1v
d M Cl II lkd J
Ap r:m*1 i» mwe with rid?. �- view s g
33 exataen@S4md (��p q `t C Z B i o
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ON. 16• we// O 0 w+
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CERTIFIED TO+ '` • GR i r
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FG 1'
MARY D. HOLLAND c f, ;;;
�ER O .r�
COMMONWEALTH LAND TITLE INSURANCE COMPANY -- - "=
%- -�;...,.._y;8!,ip,, i R �,p.4r,.vs,_., ,,•„,.,hoe.», . I ., ;.te,:,. :,w,.,3. _ -.-,, -.yv`€^w•45,,,1ww:,.;�,yrPc-'�t 0,62.1), •'y, .
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I am familiar with the STANDARDS FOR APPROVAL7•
/�� ti a!
AND CONSTRUCTION OF SUBSURFACE SEWAGE '!' • s/i • '-•,- ;•,,;s
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES VF/CO�` P ': ;;'
and will abide b the conditions set forth therein and on the '1
permit to cons ! t e,",,• '`
ii iso
' , .. `
SND S
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ,� �,5��t.MErro L�
FOR APPROVAL OF CONSTRUCTION ONLY AREA = 17,554 sq.ft. � ��' ._
ELEVATIONS ARE REFERENCED 7' (,. y'� ;F'I4 Y.S. LIC.
NO. 496/9.
., DATE HS.REF.NO. TO AN Asst.11ATD DATUK , ' • I,, Prepared In accordance with the minimum /I I 'a� �+ t�
�• standards for 1//1e surveys as established P • 'r S P.C. :- •t;"4;
by the L.I.A.L.S and approved and adopted (5/• - +: � ' a e,f�. f, i;5,
The locations of wells and cesspools
p
p k shown hereon are from field observations for such use by The New York Slate Land P. 0. .0,0" .••: ri'
APPROVED and or from data obtained from others. ' septic s s VewIe4 6 M Title Association.-
!' / /f+ • a MAIN R � i,'3,; r,:
s t. - P hse t/;y7+ SOUTHOLD, N.Y. 1197/ ':'"r
` ;,*' 94 - 145 •.