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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK �� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS (� ,�. Southold, New York 11971
Fax (516) 765
MARRIAGE OFFICER 65-1
et) ® 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. 797 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : KATHRYN PUFAHL
Address 1 : 1620 BROADWATERS ROAD
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 ON 11/19/91 .
Name Of Owner PUFAHL, KATHRYN S CANDE, KEVIN
Mailing Address 1 1620 BROADWATERS ROAD
City St Zip CUTCHOGUE NY 11-935
Property Address 1 HALLS CREEK DRIVE
HARBOR VIEW
City St Zip MATTITUCK NY 11952
Tax Map No. section 115.00 block 17 lot 17.021
Cross Street NEW SUFFOLK AVENUE
Building Permit Number Cross Reference:
Issue Date: 1/17/92 Judith T. Terry
Southold Town Clerk
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JUDITH T. TERRY J' �� '�ok`� r a pO5Bo951M9n Road
TOWN CLERK O �i �"
REGISTRAR OF VITAL STATISTICS JRA �� Southold, New York 11971
MARRIAGE OFFICER G M�®� ''V, Fax (516) 765-182365-1
-� V® ��- Telephone (516) 765 1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: January 9, 1991
Transmitted herewith is a copy of application No. 818 for a Cesspool/
Septic Tank Construction Permit submitted by:
Kathryn Pufahl .
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.
4-` )L°-e-`
JAN 17 799)
Linda J. Cooper
TOWN an 5outfiold
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recommendations:
APPROVE X
DISAPPROVE
®., �.
Comments: e.o►t.k a» a4.4A. 1 GLA-3 ' tirr.1, Q
$-%-aViv‘B-€),1\11C Go. l' - b', on �'�1‘11`�VI°1\
(.-,4:c.../do.4. (1) .0 4301-----,
Signature
1` 1 O` c\Z
Dated
•
y )
FFICE OF THE TOWN CLERK _OcJ\\tFO(k^•
Town of Southold �Q� t/
Judith T. Terry, Town Clerk � Application No.
Town Hall, 53095Main Road (=, ?. = /
Construction !/
P. 0. Box 1179 rn � ' `
Southold, New York 11971 Alteration •
Telephone '01 it Jy ! Residential
(516) 765-1801 "� Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for •
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE IS 7_-
APPLICANT NAME: Vatrk r 4 Irl PU-�� �
APPLICANT ADDRESS: )Lazo (p
•
C -k ( 1l 9
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION 71eu, CSA t1
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: cO1/4.11r- ruLtem, Rufojc eui- cct -A —
OWNER MAILING ADDRESS: ) Lyo 'I0i�CAS
eci
(7-(-) �k oc I I S
OWNER PROPERTY ADDRE+WU
S: rret,\X 'CA
TELEPHONE NUMBER OF CONTACT PERSON: ')a,1 - ( 000 r.4 (1Li
TAX MAP NO. : Section 115 Block 1i Lot 116 2-- l
CROSS STREET: c\ L �o -N)\
BUILDING PERMIT NUMBER CROSS REFERENCE:_
/
Signatur, of Appli ant
RECEIVED BY: c
Town CI rk's Office
DATE: l —f 2-
I
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\\(7Lot 28
2 I Lot 27 (VACANT)
.. c3_„' I Area = 44460 s.f.
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N.85°08'04 •W EL.I4 2 -
140.98 --,.-
TEST HOLE 00' LOt 25
LOAM
40' t 24
' (VACANT) -
SAND
100' ` - _
SINGLE FAMILY DWELLING NLY
EXPIRES TWO YEARS FROM DATE OF APPROVAL' -�-
NOTE:
• TEST HOLE AS INDICATED ON FILED MAP -'''
,
- SURVEY FOR ,
SUFFOLK COUNTY DEPARTMENT OF HEALTH 'SERVICES KEVIN C A N DE Yti'
1� k.
LOT NO. 27, " HARBOR VIEW AT MATTITUCK'� •
FOR APPROVAL OF CONSTRUCTION ONLY AT MATTI TUCK ,( DATE., OCT 15, 1991
�Qy 1 9�g9t TOWN OF SOUTHOLD ) - SCALE I" = 40' _
•
DATE RE=- ' A ' SUFFOLK COUNTY, NEW YORK NO 91 0899
' / NUIYUTHORIZ ED ALTERATION OR ADDITION TO THIS
APPROVEDArt U/ I/'/ sufV[r 4 A v1oLAnow OF SECTION not of THE", ` MEW roRK STATE EDUCATION LA■
A - M cop Es OF THIS SURVEY NOT SEARING THE LAND .,,.c OF NE)". - -
S 1 1 3 " /�c r SURVEYORS[TCON7 CONSIDERED TOSEAL
BOR E A VALIDTRUESEAL SHALL S OD W AO�P
*GUARANTEES INDICATED HEREON SHALL RUN ONLY TO .�1� YO 'I' •
-
HEALTH DEPARTMENT-DATA FOR ROW.TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED O \. G _
AND d HIS BEHALF TO THE TITLE COMPANY,GOVERN- 4 Z i
N NE WATER MAIN_MI • *SOURCE OF WATER INMATE_PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED • O
- •IIF CO TAX MAP DMT 1003 -SEC TION 113 BLOCK 17-.LOT 1721 HEREON,AND TO THE ASSIGNEES OF THE LENDING C{ + _
R THEIE ARE MO DWELLIIMAN
/ WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRSFERABLE �`r` -Y
OTHER THAN THOSE SHOWN HEREON -"1 TO AOOITIONAL INSTITUTIONS OR SUBSEQUENT '�`!�'
R THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR TRIS RESIDENCE OWNERS -
*DISTANCES SHOWN H[R[ON FROM MO►C RTY UN[f
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY NEN? TO[KIS TIM/ lTRUC TURES ME FOR A 3►ECIFIC 1,1O,
Of 00 a-
LIC* /OIrICL/ PURPOSE AND ARE NOT TO BE USED TO ESTAILISH J.
10 GAND PROPERTY LINES OR FOR THE ERECTION OF FENCES E�(AND 0•4
ADOIIEaf 1852. OLD Govr.x21 GLS - -
ul�rna�,aD TEL
�L� bda-e YOUNG YOUNG• R T oN V YOR�KE
NOTE, a=STAKE •=MONUMENT ALDEN W YOUNG,PROFESSIONAL ENGINEER _
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK AND LAND SURVEYOR N Y-S LICENSE NO 12845
OF SUFFOLK COUNTY ON AUG 21,1987 AS FILE NO 8377
`HOWARD W.YOUNG, LAND SURVEYOR _
E.. •TIE LOCATION OF WILL(WI,SE►TIC TANRISTI•CESSPOOL!(CP)MOWN N[IIEOM - -
ME PROM MELD OBSERIATIONS AID OR DATA OBTAIE /MOW OM OTHERS N Y.S.LICENSE NO 45893 - - - -'
FI
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C_ BRANDIS A SONS INC.
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