HomeMy WebLinkAboutShaw 1
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Town Hall, 53095 Main Road
i$ P.O. Box 1179
��, Southold, New York 11971
JUDITH T.TERRY = �•� i. " �,,.! TELEPHONE
TOWN CLERK ii/all/ (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 429 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : SHAW, ROBERT AND NANCY
Address 1 : P. O. BOX 475
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APPROVED AS INDICATED BY SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
ON SUBMITTED SURVEY DATED 9/29/88.
Name Of Owner SHAW, ROBERT AND NANCY
Mailing Address 1 P. O. BOX 475
City St Zip LAUREL NY 11948
Property Address 1 ALDRICH LANE
City St Zip LAUREL NY 11948
Tax Map No. section 125.00 block 1 lot 2.022
Cross Street FRANKLINVILLE ROAD
Building Permit Number Cross Reference:
Issue Date: 12/01/88 Judith T. Terry
Southold Town Clerk
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JUDITH T.TERRY � ,�� TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: November 29, 1988
Transmitted herewith is a copy of application No. 436 for a Cesspool/
Septic Tank Construction Permit submitted by:
Robert and Nancy Shaw
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 x.
DISAPPROVE
r
Comments: a �.,, CL4 C 1% 7AI.s QST. ,
DEG n 7 19 : Signature
g11G4 CIQII1 tre77-1 Dated -
OFFICE OF THE TOWN ajr
Town of Southold ®��} F CSG ' / I
36
Judith T. Terry, Town Clerk Application No. 7
Town Hall, 53095 Main Road c 417A. Construction
r O. Box 1179 u3y
Southold, New York 11971 O Alteration
Telephone el � 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 kloo. a-9, 193g/
APPLICANT NAME: "Pabef---/- 9- Alta-r7 ,5/2u7
APPLICANT ADDRESS: -Pa ZN 475
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: - �J� kla '' 31)02,6
OWNER MAILING ADDRESS: -7R Q . ,L-C.J, 475
Lr -t./ ivy i/9zL3
OWNER PROPERTY ADDRESS:
J area , AR/
TELEPHONE NUMBER OF CONTACT PERSON : c „,2915--..564/0
TAX MAP NO. : Section / 5 Block d Lot
CROSS STREET: s',1"'"'"'""'"'� IIP%-rwy
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BUILDING PERMIT NUMBER CROSS REFERENCE:
NOV2 9 'Me
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RECEIVED BY: 0-1/4114-
own
Clerk's Office
DATE: /l (99/gS(' l
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- - S!NaLE FAM;L_j DWELLING ONLY •
EXPIRES TWO YEARS FROM DATE OF APPROVAL
- SURVEY FOR
•
°UFFOLK COUNTY DEPARTMENT OF HEALTH SERVIC(t ROBERT SHAW a NANCY SHAW '
. LOT 13, "LAUREL ESTATES EAST, SECT. I I' - . '
FOR APPROVAL OF. CONSTRUCTION ONLY AT LAUREL DATE: JULY 25,1988
_ TOWN OF SOUTHOLD - SCALE: I 501
DATE Hs REF. No SO t a', SUFFOLK COUNTY, NEW YORK NO. 88-0867
' *UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY IS A VIOLATION OF SECTION 7209 OF THE i S`F'(E OF NFA,
APDQOVED NEW YORK STATE EDUCATION LAW /-
- - *COPIES OF THIS SURVEY NOT BEARWG THE LAND PRD w Op
SURVEYORS INKED-SEAL OR EMBOSSED SEAL SHALL
INOT BE CONSIDERED TO BE A VALID TRUE COPY. O� }0� t
1 3-0 (J *GUARANTEES INDICATED HEREON SHALL RUN ONLY 10 4 r �M.•
HEALTH DEPARTMENT-DATA FOR APPROINIL TO C STRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED Z
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- •n• 0
N NEAREST W RAINRI.~ N SOURCE OF WATER, PRIVATE '/-PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED • k .fid;
N SLOF CO. TAX MAP DIST loon SECTION I 2 5 BLOCK ei LOT 2.22 HEREON,AND TO THE ASSIGNEES OF THE LENDING — 's `�
OTHER SHOW THERE ARE MO 01N ! WITHIN 100 FEET OF THIS PROPERTY TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE - .
THAN THOSE SHOWN HEREON., <# 11'
N THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEM FOR THIS REEI0ENCE OWNERS �. A , ;�
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT T DISTATCES SHOWN HEREON FROM PROPERTY UNES I'
OF HEALTH SERVICES. TO EXISTING STRUCTURES ARE FOR A SPECIFIC O p t�!o>
AF PURPOSE AND ARE NOT TO BE USED TO ESTABLISH :DD SUR-
PROPERTT LINES OR FOR THE ERECTION OF FENCES
ADDRESS - • -
TE`. - YOUNG a YOUNG , ,400OHEADNNEW YORK
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"' NOTE: n=STAKE .
• ALDEN W.YOUNG,PROFESSIONAL ENGINEER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF ,• AND LAND SURVEYOR N.Y.S.LICENSE NO.12845
SUFFOLK COUNTY ON APRIL 4 , 1985 AS FILE NO.7870 -
HOWARD W.YOUNG, LAND SURVEYOR ,
*THE LOCATION OF WSLL.(W),SEPTIc TANK(ST1S CESSPOOL.S(CP)!MOWN HEREON N.Y.S.LICENSE NO.45893 ,
ARE FROM FIELD OSSERWTIONS AND OR DATA OBTAINED FROM OTHERS - - -
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