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OFFICE OF THE TOWN CLERKO� FRA-"
Town of Southold T. Terry, Town Clerk
Judith :"
Town Hall, 53095 Main Road c E
P. 0. Box 1179 .c.r3 ?.
Southold, New York 11971 O*ck),.,. �. •`
Telephone
(516) 765-1801 '
TOWN, OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 51 Residential Xx
Non-Residential
Fee $ 10.00
Septic Cesspool xx
PERMIT ISSUED TO:
NAME: Carl Park
ADDRESS: Box 279
Peconic, New York. 11958
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New House
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Carl Park
OWNER MAILING ADDRESS: Box 279
Peconic, New York 11958
OWNER PROPERTY ADDRESS : Chestnut Road
Southold, New York
TAX MAP NO. : Section 59 Block 3 Lot 4.2
CROSS STREET: Maple Lane
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
Judith T. Terr
Southold Town Clerk
DATE: October 3, 1986
(TOWN SEAL)
del
•
sd =r 7,1
'' = "' Town Hall, 53095 Main Road
A 4 P.O. Box 728
Via'. r� Southold, New York 11971
JUDITH T TERRY .044rJV TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
October 3, 1986
Carl Park
Box 279
Peconic, New York. 11958
Re: Chestnut Road
Southold, New York
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10. 00) for
residential use and twenty-five dollars ($25. 00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly yours,
Judith T. Terry `f
Southold Town Clerk
Enclosures (3)
JTT/Ijc
OFFICE ,OF THE TOWN CLERK
Town of Southold
Judith, T. Terry, Town Clerk Application No. 7
Town Hall, 53095 Main Road Construction
P. O. Box 1179
Southold, New York 11971 Alteration
Telephone •
Residential
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
RECEIVED SOUTHOLD WASTEWATER DISPOSAL DISTRICT
SEP 2 91986
Town Cork Southold APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. Li/
Fee .$ f/c �p
DATE -(
APPLICANT NAME: C- Ta3de--
APPLICANT ADDRESS:] -011G A79 NY+ 1 I 15S
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTIONC S(R. ALTERATION:
OWNER OF PROPERTY: CC,C
OWNER MAILING ADDRESS: , I` ;&7 1
OWNER PROPERTY ADDRESS: ce,.._a&u.kt
N,y,
TELEPHONE NUMBER OF CONTACT PERSON: 72 -Sd 6,r
TAX MAP NO. : Section ? Block Lot
CROSS STREET: '/t)c - c ' -i,U
BUILDING PERMIT NUMBER CROSS REFERENCE: 411F' `:,
41
• Si• ure of Applicant
RECEIVED BY
Town ier15;e9Vece
DATED , 02 r / (_ •
• ' . NOTE: APPROVED FOR INDIVIDUAL , ___ _ . ---,-,-
'I
-r,...,�_
�.4 � h^t\
I = RATER SUPPLY AND SEWAGE {' .
DISPOSAL SYSTEM. .''''' ...#,. �j n
10 .
( Vacant) . JUN 27 19O DO
a
-C
W
i ( 50 0) CHESTNUT ROAD (4 8SC DEPT�OF DO
EA,LTH ARVICES , 0
150. 00� _
N. 47 °49'40��E . _
-,► set '�(, 2) /9L 86'
p`Pe ('19.%) sfk
set I
in
O CO
L.
P r oet 0. o o _ t•
alit - O . O cod
cg Q
IQs
mo�o , 0 ®
tI o V 4i Y.s�
Vii's 46.6 test "1• r1
1 47 gm ® hole
a �2
-10 CC
-6--u- 0
I • a, ° AREA = 30,522 SQ. FT P ®
TEST HOLE
a~ J Q ins fi
on: Z . .
I Jnr d3 •� ,� sozZ
0 2p'
$ r... . . .. PLEASE NOTE o
0 °, N 3 40' LOQm
O
CO It is the 4 pplicant's responsibility to ' o
° maintain adequate sanitary distance a sang'
between all water supply and sewage '°. some
"t : disposal facilities. Loam
a cn
sed 8D,
(48.1) P,p ,... , . . , ,...__. , ,.., ..., ' ter F 3) Rocks
}, S. 47 °49 '4011 151. 82' M A P
I 152. 451ACT
4 N/O f F HELEN M. CONWAY
• SINGLE FAMILY DWELLING ONLY
EXPIRES TWO YEARS(FROWDATE OF APPROVAL, .
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES SURVEY FOR
I, FOR APPROVAL OF LCONSTRUCTION ONLY ISA ., K
DATE 7- '- HS REF. NO. �/b 'SO (c). , AT SOUTHOLD
APPROVED �' drTOWN OF SOUTHOL
SUFFOLK COUNTY, N.Y.
qac pq - 4.2
1'000 = 0 59 - 03
The wafer supply 8 sewage disposal Sys- 1 ".
„_ 0 ,
tams for this residence will conform to the SCALE
of standards of the Suffolk County Depart-
JAN3 ,
ment of Health Services.
1986
1. _ CXOY/ a AA Ak_ ClA
GLANDS
44 # bit 42. 'N 1 D Z19 P
. -o N A. 1N F 9 Prepared in accordance with the minimum
c p G' �„� c7andards for title surveys as established by
r �O' nye L.1.A.L.S. and approved and adopted
* r Vitt �'�,' �'-Q.C'VL 12r 1 v" C Cor such use by The New York State Land
•-,._3• 4 l�J `title Association.
/' NI 44 -i.•.e®;_�'�'/ N.Y.. S. LIC. NO. 49668
P�`COOps-.....A1‘
a ENGINEERS, P.C.
A (5)6 ) 76 -,`f 20
P. O. BOX 909 '
MAIN ROAD
1 SOUTHOLD, N. Y. , 11971
86 - 124