HomeMy WebLinkAboutPetersen • •
OFFICE OF THE TOWN CLERK C3IFU(/r`, -
Town of Southold , DO. 0�
Judith T. Terry, Town Clerk
Town Hall, 53095 Main Road a -mac
P. O. Box 1179 � •.. �:
Southold, New York 11971 Owl `aq qtr
Telephone - ! i '
(516) 765-1801 •
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 17 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspool XX
PERMIT ISSUED TO: -
NAME: William J. Solan
ADDRESS: 35 HIllside Road
Stony Brook, New York 11790
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
Two story residential home with system
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Ron Petersen
OWNER MAILING ADDRESS: P.O. Box 1258, Mattituck Inlet Dryland Marina
Mattituck, New York 11952
OWNER PROPERTY ADDRESS: Sound View Avenue
Southold, New York
TAX MAP NO. : Section 54 Block 6 Lot 3
CROSS STREET: Hickory Road
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
udith `r.v i"err
Southold Town Clerk - -
DATE : August 28, 1986
(TOWN SEAL)
•
OFFICE OF THE TOWN CLERK
Town of Southold
Judith T. Terry, Town Clerk Application No.
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
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL •
/IPermit No. �
Fee $
DATE ‘/
APPLICANT NAME: Le), //1 p/--e d G,g1y
APPLICANT ADDRESS: j <-57/r C 1 S't c ! I .5-'7;)// fU.-Q, I " //7
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
,q,. 5 4/- ..-A.) 9.-_<-bLe) S ,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: R- `
OWNER OF PROPERTY: i c pr ���•c
OWNER MAILING ADDRESS: /'1,4174,%uz e,K ,1�� _Pry C /19-r>A;
_- X1.1/. 1/
OWNER PROPERTY ADDRESS: 5A rrip
TELEPHONE NUMBER OF CONTACT PERSON: 7`j ,
TAX MAP NO. : Section Q S Block 6 Lot 3
CROSS STREET: •, .j U 1--Cti )-0-()"
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signatur••'of Applican
RECEIVED BY:4 -�c._
Town erk's 0 fice
DATE: f ' 4 - 66.
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----- ---•- y SUFFOLK CO HEALTH DEPT. APPROVAL Ii
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rAC2.`�-- - —'�I - ! '�PU P f 4f.}� tcs--lri-F_S TWO YEARS FROM nATE' CF APPF--4 ;�..t,4�'
STATEMENT OF INTENT
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— - ' ; -- FM.C.." ; r, THE WATER SUPPLY AND SEWAGE DISPOSAL
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YOVIN-`w' '� . iUTP0t�.i� N.Y. .
SUFFOLK COUNTY DEPT. OF HEALTH
SERVICES — FOR APPROVAL OF
CONSTRUCTION ONLY
ADATE: � 7-z -- -.
H. S. REF. NO.: 00 I • 1
/� \� APPROVED: I 1`og,ti.. A
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6 SUFFOLK CO. TAX MAP D - •ATION:
)/ DIST. SECT. BLOCK PCL.
�' 1Q00 054 -
, .. 8)k21g� OWNERS ADDRESS:
i • clo MAI-TITUG: It-•41._ET �-f�Y LAND MAPINH
• MA-1"F`1 .1Z:—.Z ',3:Y. 11952.
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29S- ' '726
`-'7";_c-ALE 0 I Y DEED: L,7.1".,!2 P. +
�,1�( J +-'J! J,I:_ TEST HOLE STAMP
f a i y.^----- - Untulthorl-;G alteration or addl•itn
to this survey iso violation of
�'"��`- . S�>ctlon 77.•^'4!the fdru!'York Smote
.. _-__�_--_-_. i Education Lem
11• ii OAN DY Coniez of till..aorocy ms9 r.:rt baaerinl
of" �!-�I 1 the I arsd surveyor's irked sed err
w ,_-_ smh.^.ss'a:soil oh*,t'not ho conticiored
• ® ------- 4 to be a valid truo copy.
Nr-...\,0 I�_S fe.E.1.:1:717,;. + M E 1 i J v3 F t ;..EV L. ?se J Z.:LAY 7 Gus:entera'Irs,"icsto heroes ea RBI
I% only to the person for VATO t the survey
— 11%7011.4174q
" ` Is prepared.and on his behalf:to the
�' ��+ •.."1.0
this company.Bova rmantel agent'end
!}' ; '�h1�. Iocue,+nt Institution listed horoon and
. tr= ....; = to the acgatm•es of era lend'Inp Insti-
tirirx+.CsllHrantmos oro not trsnsforalsl®
_ to sc,Gitlonai Institution;or s.d.•s+gwrK
. JUL 8 1936" ' y, ------___ - Own.ra.
SEAL
t' I-ILA•v'e
lir S C DEPT CF s .-i,-i:'; E'L_ of NES
REAM�l SiiRkIC S (:*-ti ra -L112 ./EYF'P JULY f Icye ;� I-
ROAR ICK VAN TUYL. P.C. 1 6 • a ,. ' r`- +►
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LICENSED LAND SURVEYORS �tis+F�cS 2,6'' �
- GREENPORT NEW YORK t. i