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JUDITH T. TERRY ; l+ Town Hall, 53095 Main Road
TOWN CLERK -
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rZ P.O. Box 1179
REGISTRAR OF VITAL STATISTICS trs Southold, New York 11971 •
MARRIAGE OFFICER Q ®� . Fax (516) 765-1823
=_',yt 1D •I� 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. 951 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RON MOR I ZZO BUILDER, INC.
Address 1 : P. O. BOX 789
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 10/15/92.
Name Of Owner PALMER, MAYNARD
Mailing Address 1 P. O. BOX 332
City St Zip CUTCHOGUE NY 11935
Property Address 1 JOHNS ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 122.00 block 3 lot 16.000
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 1/15/93 Judith T. Terry
Southold Town Clerk
1-rnwN 'l4.i
JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK (1,
P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
�
MARRIAGE OFFICER ®v �.'' Fax (516) 765-1823
; �t Telephone (516) 765-1801
•
OFFICE OF THE TOWN CLERK " •
TOWN OF SOUTHOLD l
JAN - 5 1993 P;;y
TO: Southold Town Building Department _ c 13114DL! iJldl'�•
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: January 5, 1993
Transmitted herewith is a copy of application No. 978 for a Cesspool/
Septic Tank Construction Permit submitted by:
Ron Morizzo for Maynard Palmer
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.
1,9
Linda J. Cooper
* * * * * * * * * * * *
I
have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE 0�
DISAPPROVE
Comments: ctoc, Q,Jy, 1�1DN ZIAA"CI-1d
0 /rig X-
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Signature
'1 51\01/4,44.
Dated
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O,FFIC,t OF THE TOWN CLERK c,�VFOLi'/;'�
Town of Southold cN)K ` �0� p
Judith Tr Terry, Town Clerk , )-(.=4 6 Application No. -7i0
Town Hall, 53095 Main Road o ?.�% . =
1'hffs Construction
P. O. Box 1179
Southold, New York 11971 O, Alteration
Telephone �l •
zc ���rlcO Residential
(516) 765-1801 "P.
Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
•
for
CONSTRUCTION or ALTERATION PERMIT .
SEPTIC TANK or CESSPOOL
Permit No.
•
Fee .$ /0,63
DATE Valo3
APPLICANT NAME: k.01 YYlO(I72-0 BV11OLY. .271(1C—.
APPLICANT ADDRESS: Q,® , 60)(._ ----/Sq
‘..0o 04-1nor dot Ii -. icy?
SEPTIC ✓ CESSPOOL .‘/
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
-3k n(31 I. olLSLIQ o
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: f aljnar / Pal rme-r
OWNER MAILING ADDRESS: Q•O tbox
et--airkeye_ cy2DS
OWNER PROPERTY ADDRESS: ybrks :Load
d
mC - --1 L L 1, 1Q5
TELEPHONE NUMBER OF CONTACT• PERSON: 7(05-8-170..
TAX MAP NO. : Section i L2. Block 03 Lot R40
_ CROSS STREET: es54- ma n eoacj
BUILDING PERMIT NUMBER CROSS REFERENCE:_.
OatA a_ / o
Signature of Ap„fp{nt
RECEIVED BY: , (A„1/()-4(1--,
•
Tot n Clerk's Office
DATE: f_3
-• - Hi ,eEf NO ' aS So aq- -
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES �r�i �,.tx a° f j ,d,"r": /":/ •
• FOR APPROVAL OF CONSTRUCTION ONLY G,: am, ° � < tih
' -.41 r 8- - 1*- /2
98 -
DATF� -EF. NO , .
. _
to \ 3
, , . . _ ,
i . 4 , . . 0
APPRQVED I� ' ' - .e/
_ •�• f�G J�(�� t Q-�
_: ' •110..► ...... Lys`�� �(� 5
?I. e-,) - 14/0 SITE
R r # e p �F% IP IF ' J
The, water supply and sewage N SeQly L �i�
• systems for fns-residence awW.oonf• ^ \53,-0/ t`i, ` LL� 1--. �i,�,! \
to the standards of"The Suffolk Corny • t1 P sp_ ��Or .ov 6v f e�' . •"P i'6). I- ' -�-ate, �G.Q eP t '
Deparhnent of Health.Services. • , \o t 6� / g 9 o.
O
O
TEST :BdR,1 IG cn O .\,�� .r. 5{0°'" l/ , , \131-4-
,-
•
brows N O�F �� '�� OS+ / �_ __ . -J.- - \z\
• /': /o�rn�! sa.n d �I G�Q �� ��'� ri! // _'may yam\ �O
G' '\3 05� \6 1' aa7..5. :'-'1'
. LOCATION MAP, -4\ ,
ip
: t'own \ ��j\ I J: / s gyp/ \-c`
`5."7 - M"Ce- .,- - - \ a �. (Sell) • \ % `�� F+' E _LEG/ON �D \
_ .-.-_ _ _ � _ .....
`T ((4 •'' Q v {•°'� i -�
afer • 7.5.42:E1'4;6 �. o A/ ��+�� � t` �y o / / l _ C"'
1 s 4,A,VI. _ o !5. r �� UIRED
�' � 9 s eon &,,,
�7` ;1' /. ��'' ;' •' ' . 1a` 'L A , APPROVAL.
�D� >o ='" 2 •
` - • PRIOR TO FIN .
.. . _ . \ osry I� 2y .
t : • ' ��'�� V Q�,�, SURVEY D
\ r = e.• pc t o� a'( PROPERTY -
AT MATT ITUCK
v 0' l
�` �/ :, �., TOWN OF SOUTHOLD
a N4et LINTY N. Y
• q sQ ra, ,�P SUFFOLK COUNTY�,
- • ti \' - ' OF 1000 - 122 - 03 - 16
1 \ �- 71 J '..\
__ ' ` ' SCALE: 1' 40'
. . _ ��,,��P _-'' / AUG'. 5,199/ ,
`�x�_ - Y . - - .SFPr io /9
D • '7 SEPT. Zj 9/�cimo�o fj/)
• (# 1e,�aGF �-� coq ;„,11Y
' .../ -'' :"It'''',.-j•).1,4: 73) '. -: • • S ..." ."-.. ,, , • , 'i.',.4: ' . ' . ig'0(_C;
� ? C -- • - Prepared hr a+ccordmce with Me minimum
3" • R standards for title surveys as eslabllshed c 1991
j� `�� �• F /_ • t ^rHw�+ -z by the L.I.A.I S and approved and adopted . Si-V. 30
�I �' }.�j� � / - '` - for such use by The New York S/ale Land "•
9 i' LIC. NO. 496/B
7', i.iy�;. �i �•l Title Association.
_. , .Me locations of wells and cesspools shown hereon are from Mf/
PECONI =, _'P.C. observal%ons and or from data obtained from others. -- r• - P7. OF
15/61 765 - 5020 ' e/r3 ,PraPose' e/e Vo-�f•c •� -.;1..'.' - ilEALTh SERVICES
- R O:. BOX -.909 ."-'----_ . . - . ' •
MAIN' .ROAD• .-" '' ' ` ' - .. O - I,f✓r'c Poo% r
• ELEVATIONS TIONS ARE REFERENCED
SOUT.HO�D, N.Y.. v�7/ 1� ti>" AR EA = 20 , 641 SQ.FT. TO AN ASSUMED DATUM.
9..5f/ma..44C.d ar7acvn'11 -t3-7 T///,7-450 ect�'' g��
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