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JUDITH T. TERRY ; �► Town Hall, 53095 Main Road
TOWN CLERK T P.O. BOx 1179
REGISTRAR OF VITAL STATISTICS CP
�� Southold, New York 11971
MARRIAGE OFFICER �0, , Fax (516) 765-1823
�,yol + $�®'��,00 Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1042 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : DANIEL SULLIVAN
Address 1 : 14 ABRAM'S PLACE
City St Zip LYNBROOK NY 11563
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES ON 4/30/93. REF. #93-SO-42.
Name Of Owner SULLIVAN, DANIEL
Mailing Address 1 14 ABRAM'S PLACE
City St Zip LYNBROOK NY 11563
Property Address 1 HILL ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 63.00 block 7 lot 17.002
Cross Street HILL ROAD WEST
Building Permit Number Cross Reference:
Issue Date: 9/09/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRYTown Hall, 53095 Main Road
TOWN CLERK ® I P.O. Box 1179
REGISTRAR OF VITAL STATISTICS r'&P Southold, New York 11971
MARRIAGE OFFICER 10 &1
�4, Fax (516) 765-1823
��® 0 � ��! Telephone (516) 765-1801
OFFICE OF THE TOWN CLERI
TOWN OF SOUTHOLD �`�°-�1 7 � '��av
lli il ' i
TO: Southold Town Building Department LiSFp 3 /993 ;,i
FROM: Linda Cooper, Southold Town Clerk's Of lice _ rff�
DATED: September 3, 1993 , �o' . .:,%-7.4Q„ir. �”
Transmitted herewith is a copy of application No. 1074 for an
ALTERATION PERMIT for a cesspool or septic system submitted by
Carol Cassel
Please review the application and location map and advise if this office may
issue the permit.
Please complete the form below and return it to this office.
Thank you.
Linda J. Cooper
* * * * * * * * * * * * *
I have reviewed the application and location map of the project listed
above and make the following recommendation:
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APPROVE - c/
DISAPPROVE -
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OMMENTS: VI / . famed/ , 1/L1 � !. �:r �� .
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Signatur-
972 Ail "?'
Date
OFFICE OF THE TOWN CLERK ��� - , •
Town of Southold Q;�t i J(,(��, �' `per
Judith T. Terry, Com- `- ,-
Town Clerk j!r'"`` `; `(4. Application No. 167
Town Hall, 53095 Main Road ~
P. O. Box 1179 u-, pi;`•% 4�,�1 _ Construction -
Southold, New York 11971 O.' '�'�'� :' `c
-"Cl/ Off- Alteration
Telephone "Ol .tsf4 s PIV Residential r,-.(516) 765- 1801 • ' ,fes
Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
- _ APPLICATION
•
• for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
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Fee $
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DATE ',, , 3
APPLICANT NAME: 1 ,i "
sc- 4_-
APPLICANT ADDRESS: a3� ,,tey p'4j lead. •
- r ' 57- P.VTc o Glc
SEPTIC CESSPOOL v // L
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION Teat) aG'lt-� ae_
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LOCATION MAP: Must be attached hereto before permit may be issued. 1-------
LOCATION OF PROPOSED CONST ' UCTION OR
OWNER OF PROPERTY: G ERATION:
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• OWNER MAILING ADDRESS: '1
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OWNER PROPERTY ADDRESS: / -,
f ... 4,-40-u) 4-4 ' j . ..
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TELEPHONE NUMBER OF CONTACT. PERSON: ,,er9_ s-
ea-4.4...1 &Le 4..c.g-
TAX MAP NO. : Section D,5"'ro. Block "--
• Lot
CROSS STREET: . „Ac.:_....,,_, 41 ,...._ .
BUILDING PERMIT NUMBER CROSS REFERENCE:.
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Signature of Applicant - •
RECEIVED BY:�/l�f //,--A-1 '
/Town Cleric's fico
DATE: 9�1 ate'
9 a So i � G
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NAI' ',"3--•WILLOW P'OIrs-1T / \\ SUFFOLK CO HEALTH DEPT.APPROVALeq
'_II I- ') f-'A,i-' 11'D 4�5z / ; • H S NO, T 1► ,
\\� MAP OF PIZOP�fZTY e y'
2F' �( \ �UrZVEYEC� FOIL �' .0- 'r
,°C2117G,-j1'04\Pq 4,7' \ I Y I
JAES 4 CA2O1.� CASSEL STATEMENT OF INTENT t
tGu , �� ` THE WATER SUPPLY AND SEWAGE DISPOSAL
� ��t^A� 4 u \ AT SYSTEMS FOR THIS RESIDENCE WILL
r CONFORM TO THE STANDARDS OF THE
- - - eLrr_ItI_Iz(-0‘,1 -r- �/AY pp` %9 �O�J i IiGLD
Ip \ - SUFFOLK CO DEPT OF HEALTH SERVICES •
os- � 7 TOWN c OF` 5001-I-1UL-U ,NJ.Y (SI
•• [ 1•-_-; .-N 3T,,8.20 4-• \ `� ---• ---------- APPLICANT
J ,th ?, •o SEPTIC
• •//A, ,, rG� I-1- 1" 5-roNE/GRAVEL. \ SUFFOLK COUNTY DEPT OF HEALTH- '
rJ e" ` 5�e ;----- 1• I D21VE //\
SERVICES - FOR APPROVAL OF17.x,31 ,, r�E7wv� �o- W �� $Q
h;(_ (JV. , ),9 •o-- � -t I 1 r1.• :� \ \ CONSTRUChJ3 Y E9L
�--- 11: � j�,Gr:/' coat �_ S^ ✓^ h
tv
• �` i 4 ( ot2 i 4 1 ...tic 1r / DATE
I f-e.1 _t'no �" t •�'1, CONN.TO 1 .,OLD TEST LADLE
III'' I t, 1. � 1� PUBLIC WATEQ \ •, Y H S REF NO �- ��6
FILL EST L500 CU.YD - y7 wr % } \j ct
PROV AT
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WA2NY \ '0 , I-IouSE 1-- i./ -'! .„,:i• 55- co• • / SUFFOLK CO FAX MAP DESIGNATION
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;f DIST SECT BLOCK PCL
�:��� / ,, ,i CLAY 1ax� 056
- ` IYI �'////Ga7 9, • 1 •/' OWNERS ADDRESS
[ HOLI`�E ! t.t) DECK / r / ‘t>":,/,
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t^(Put3uc WATE2)� I �/-9� h`. ;se, \ .. . a,: ✓ i�py��ny yy� �apay� .�I�y�'.p�r33 PfCT{/AT�ROAID .' . d
__.i ! \P -:I ��-8/ / '`\ ! -9P. /t / NYiA1n ,T INSPECTION REG 1�, SiS2 'EAST PLSTCHIX�L!"C,r�trt:•►I�`�. ,
\'f' �'r. =" _ 1_9_// 6.4.,
V , • 'rte.-- 2E•V 15ED riTAL wai-LAND LINE , _ 'r SG' _ .1 .- _
�i / ESTABLISHED BY NYSOEC AND
— h4?' EN•COIJSULTANT:,JULY 14,1993. - -TEL. 2893'93S'I ' ,
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ry� } sA °v :.LACE' OI=( ,•,.CESSFbOI_ DEED L 6910 P.222Ck1=F.�
h, �'� a Iv,, • • m'N jJ Al EA•26 OOO=S.F..I J�d= " (SOS f](P� TEST HOLE STA4P ,
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d 8 / - _ r , -_l c Unaothonzed alteration or addEkn 'Y
& p; � (. •MONUMENT I - *_TANK, to this survey is aviolationof
Section n La of the Naw York Stora
CL p;lf2ON PI'f-'1.-_- °;.�i• DRYWELL er[owN Education law 1 .
'C7 i . -- -- - Coplee of dila cunrey,nsp rpt
`Y q, +•y 4)' to j�- .. uAvev� 1 I� the lBlW wrvaYor.hlk.d Wl p
_ �_.. ,J,,,. s2owu end,'cased Deal NM natty wruldord
:7` •,d '+,' '8.' -�~i3p;' S �' LGAMY CLAY b be a valid Ino copy, `l-1
c "1 er7�'` •,�. 6DGy- {' y _____-2' Guarantees Medd Arson stns nm + y
yl t ' I LE`,IATION5 12E i�E5r2"TO MEA1�1 SEA LEVEL'NGVD. BROWN onytothopreen WINN:nthesu,vey
kb behalf to dm
_ _ -,� Q µP.12 c1 pa PREM^1sEa_,,NI 54.300 ZONE A-1lGL_45- ' •'. CLAY Is lith,me0a`nyaany,governmental tala and
otto NICK w r - -- ------44 lending lneLWban Lewd hereon and
t i r 1 - 1 t ` b tits assignees of Ne lendfnp tnstl-
t ` " tuson Guarantees WO,CI anafera64 ,
T-rIES -" t ' TZti•tF r'^�.-�.'ASI.1�1 I �h� 7 toeIbna14•aLWWlls or
20GtG JE '' � A•- t 986 i.�AN.29,19B�;�P2-..,1986;' owners. tWbaayuaxd ,
(177- `) t� AP12!IT,19S�;FEF3.Ip,1988;NOV_5,1992;FLf3.25 1993 i WATER IN
I Fl..IPA Cf SAY MAG' Si 1993;JUNE 2S,I 3 JULY I(o it j� AUG BROWN CLAY i'
• l SOUTHOLTJ _ - -- -- '�J9�J3 SEAL
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`�0►-0—'s�'�^ bs 4UG 18 1993 AvSC}RViR Eir NOV,22,1985 WATER IN 4� - `* * 'q
-- v -r :< • ( ) RQj�ER CK VALYL,P.C. RALE BROWN 1,1410115. m 1Ic 4.r
.1 ( 5.5 POOL(5) yT 2' .WATE¢PfZDOF 't - '.,,.� ---- I ' - FINE TO n no.lsax� ° _,t i
.1�1 4sOING PLAN i TANfG { RET WALL COgRzE°ARID FiS P =�" ^"
i •� S.C.DEPT.Df LICENSED LAND SURVEYORS gg' EG LANG SJ,
GROUND WATER--77. SERVICES
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