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JUDITH T.TERRY _ Town Hall,53095 Main Road
%TOWN CLERK ® " "
P.O.Box 1179
REGISTRAR OF VITAL STATISTICS (2)
t% Southold,New York 11971
�y . � it Fax(516)765-1823
MARRIAGE OFFICER d,Volo MANAGEMENT OFFICER ®8 ED V od Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER ,.•"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1375 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : JOHN BERTANI BUILDER INC.
Address 1 : 1380 OAKWOOD DRIVE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. SCHD REF. #R10-95-0086
Name Of Owner STEPHENS, LESTER P.
Mailing Address 1 30 MOUNTAIN CUT
City St Zip MANHASSET NY 11030
Property Address 1 TERRY LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 65.00 block 1 lot 22.000
Cross Street HOBART ROAD
Building Permit Number Cross Reference:
Issue Date: 8/23/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T.TERRY te _. ., \� , Town Hall,53095 Main Road
TOWN CLERK t - `" g t P.O.Box 1179
'�t Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ``�i O ®4 Fax(516)765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER ®1 ED l".d1 Telephone(516)765-1800
- FREEDOM OF INFORMATION OFFICER —././//1°°�
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I. �' AUS D C�' --� � OFFICE OF THE TOWN CLERK
�__ __._ _. TOWN OF SOUTHOLD
�' 8111..i.-DEPT.
L___ TOWN OF SOUTtIOLP_.,_j
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: August 18, 1995
Transmitted herewith is a copy of application No. 1426 for a Cesspool/
Septic Tank Construction Permit submitted by:
John Bertani for Lester P. Stephens
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
DISAPPROVE,/
Comments: 8-C.,/,:k) )1144—‘110/9/ i:?," :0667) -- 95--- C
40,1:-€1/7
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Dated
I
,,,.
HE TOWN CLERK �cj\FFUC,j'C&
_
of Southold 0� ��`'"
G Application No./ r
. Terry, Town Clerk ••
fall, 53095 Main Road cri t ,,. £x ? Construction
°P. O. Box 1179 ® :�` _ J Alteration
-hold, New York 11971 ,$.
Telephone -�l �
Residential
(516) 765-1801 "'
,� �;� ;Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DIST~F*ICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL '
Permit No. ( 4l 6 •
Fee $ /(),
DATE
' Prii'la 9i) I gCn
APPLICANT NAME: J oh (-1 agr1r-r i3i1 [G1-u-
APPLICANT ADDRESS: 13i- Orj_tu ?RJ _ a--
S(4,0--G 11c-7
SEPTIC / CESSPOOL /
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
nse.0 h D m e, Cow'-k-ruLc-h o
•
LOCATION MAP: Must be attached hereto before permit may be issued.
• LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: \\_e...4 P. f\-0-0\
OWNER MAILING ADDRESS: 3k_) 1 IOL ��, -� MCOh0.JS-2.'j` 0030
OWNER PROPERTY ADDRESS: "Te-irvi3
cvo `}-Gt 11�1 r
TELEPHONE NUMBER OF CONTACT PERSON: `](0.c- 1 VT--1 "1
TAX MAP NO. :- Section l01 Block Cil Lot 2 2-
CROSS STREET: \ - - \C�
BUILDING PERMIT NUMBER CROSS REFERENCE:
CYCAACA- Cadt2,C -
Signature of Applicant
RECEIVED BY: REMED
Town Clerk's Office
DATE: AUG 1 8 1995
(on Cork Cork Soutlrrt - .
ry., h SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FON APPROVAL OF CONSTRUCTION ONLY i '
` 116 15 1 la -25—'c�tz6 wwII
O DAT HS.REF,NO. 1`-
-574„:1-• APPROVE i
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ELEVATIONS AREERENCED TO KG.V.D. / '
LT,.. 611 -
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SURVEYFOR {'
LESTER' J.; STEPHENS . :
AT SOUTHOLD ' AREA = 27,553 sq .ft.
TOWN OFSOUTHOLD - to tie line,
SUFFOLK COUNTY, N. Y. . �` .
woo-65- 01-22
Scale: 1"-= 40'
Feb. 2,1995 CERTIFIED TOf
May 9,1995 (Health Dept. Into 1 f LESTER J STEPHENS; JR.
CA EBSTSC PCE OF,NEW YORK
ABSTRACT
C
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/ am lamlllar, with the STANDARD'S-FOR-APPROVAL I
AND CONSTRUCTION OF SUBSURFACE SEWAGEI '
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES ; -
and will abide by Ike conditions set forth (herein and on the , =E,
permil Io construct. , ' -�
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