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OFFICE OF THE TOWN CLERK �FFOLA-
Town of Southold �� CSG
Judith T. Terry, Town Clerk 1`
Town Hall, 53095 Main Road
P. O. Box 1179
Southold, New York 11971 O lO� ��'
Telephone 01 ,�•e
(516) 765-1801 '
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 35 Residential XX
Non-Residential
Fee $ 10.00
Septic Cesspoolxx
PERMIT ISSUED TO:
NAME: Wilbur Verity and Carlece Verity
ADDRESS: 420 Cedar Drive
Southold, New York 11971
DESCRIPTION OF PROPOSED CONSTRUCTION or ALTERATION
New house
LOCATION OF PROPOSED CONSTRUCTION or ALTERATION:
OWNER OF PROPERTY: Wilbur Verity
OWNER MAILING ADDRESS: 420 Cedar Drive
Soutohld, New York 11971
OWNER PROPERTY ADDRESS: Main Bayview Road
Southold, New York
TAX MAP NO. : Section 70 Block 5 Lot 27
CROSS STREET: 90 Fr. North of Pine Neck Road
BUILDING PERMIT NUMBER CROSS REFERENCE: Pending
em �
Judith T. Terry"--
Southold Town Clerk
DATE: September 11, 1986
(TOWN SEAL)
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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
September 11, 1986
Wilbur and Carlece Verity
420 Cedar Drive
Southold, New York 11971
Re: Main Bayview Road
Southold, New York
Enclosed herewith is the Construction, Alteration or Modification
Permit for a Septic Tank or Cesspool System for which you applied.
Please be advised that each owner of real property operating an
on-site sewage disposal system, such as a septic tank or cesspool must,
prior to such operation, possess in the name of the owner an Operation
Permit for the system. The Operation Permit is issued by the Town
Clerk's Office.
The fee for an Operation Permit is ten dollars ($10.00) for
residential use and twenty-five dollars ($25.00) for non-residential.
Please have the owner complete the enclosed Application for an Operation
Permit and return it to this office along with the proper fee.
For your general information I have enclosed an Informational
Bulletin regarding the Scavenger Waste Laws adopted by the Southold
Town Board. Should you have any questions pertaining to either permits
or the Scavenger Waste Laws, please do not hesitate to contact this
office. We will be glad to assist you in any way possible.
Very truly yours,
Judith T. Terry
Southold Town Clerk
Enclosures (3) -
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- ���0Southold, New York 11971
JUDITH T TERRY TELEPHONE
TOWN CLERK (516)765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 9, 1986
To: Victor Lessard, Southold Town Building Department
From: Judith T. Terry, Southold Town Clerk
Transmitted herewith is a copy of application No. 37 for a
CONSTRUCTION or ALTERATION Permit for a cesspool or septic system
submitted by Wilbur Verity and Carlece Verity •
Please review the application and location map and advise if the
project has received Suffolk County Health Department approval
and if we may issue the permit.
Please complete the form below and return it to my office.
Thank you.
Judith T. Terry
Southold Town Clerk
* * * * * * * * *
I have reviewed the application and location map of the project
cited above and make the following recommendation:
APPROVE -
DISAPPROVE -
COMMENTS:
Signature
Date
OFFICE OF THE TOWN CLERK
Town of Southold
Judith, T. Terry, Town Clerk Application No. �7
Town Hall, 53095 Main Road Construction
P. 0. 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
Permit No. 3L
Fee $ /O
D'AT E 9
APPLICANT NAME: ����," 0// (1 e 7/-44,)1
/,
ADDRESS: � ' 2 C�P24, �/
s/1),„1"/„.04/ /0--;/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION //eal As,e.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 4}/6u '
OWNER MAILING ADDRESS: V,20
soee/Xo //g.
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: ,r`/gs f
TAX MAP NO. : Section '/4 Block S Lot
CROSS STREET: 76 /TX ,4 o /? Aqe /7eci ,a9d
BUILDING PERMIT NUMBER CROSS REFERENCE:
f
Signature of Appli.Eant
•
RECEIVED BY:
Town Clerk's Office
DATE:
`o-- l`''f/ZA',• ily Z o r•�/\ ,01, COG(// /d /g /77//
i N 14
N / 0/ F GEORGE
H • SMITH
a CHARLOTTE M. SMITH
Q ( dwelling ) Q
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n 825mon l S. 86 ° 2700"E wa44;i(
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28.1 39' .3J, 200, 0 8' � 0
w • mo�n w
Wcr
-- - - - 310
3 Prop 29' 1 la J Q
> `o dri vewo y �. M r1.1 N
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k c CO o �� Q TEST HOLE o .- c O
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C) � , Z9r 0e1.310 0) r.....
Z d° o > 0
Z 10' °O z
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30.00 t fge Q
N. 86 ° 26 '40 " w. fo �, cfi
CI - 30.1
2 199. 61 ' 30.5
ROSE ,I6 5 -, o
N_ aPLC`H Mri - z
M•
` m ( dwelling ) 3t
r• ►'• .41 '164 a D
It is the applicant's rospon&iblll rtO
ins'` ll�Qaln adequateeanitsry distance TEST HOLE
between alt water supply and sewage/1J 24 1981 a f. 310
disposal facilities. brown
loam
- s,c-' DEFT. OF
31
HEAITI 34VIC'ES
PINE NECK ROAD Pa/e
brawn
The water supply & sewage disposal sys- coarse
terns for this residence will conform to the sand
standards of the Suffolk County Depart-
A R EA = 14 , 950 S Q. FT. i`� Hea services.
—
gGG 171
CERTIFIED TO
COMMONWEALTH LAND SURVEY FOR
TITLE INSURANCE COMPANY
TITLE NO. G 624 - 948 - S WILBUR VERITY
WILBUR VERITY
CARLECE VERITY a
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CARLECE VERITY
FOR PR - iVAL OF CCNSTRUCTICN ONLY A T S O U T H O L D
g
DATE ` �' yF. T(.9S0 SUFFOLK COUNTY N. Y.
APPRIVED �1� � -- lG 1000 - 70 - 05 - 27.
SCALE I" = 40 '
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•� ,,,t,.:,,,.;,,,t,.:,,,.; � wM Gt`lC9‘s--1 JUNE IS , 1986
--' ,:;c1!� `.• • - ; ,. p_ JULY 22 , 1986
LAN®
., ?0 -' �-./,61 �,� I Prepared in accordance with the minimum
.,1 ;.`� s t O (�� standards for title surveys as established by
* ! •�r, 5 the L.I.A.L.S. and approved and adopts:
�
N, '` N. Y. S. LIC. NO. 49 66 8 for such use by The New York St to La•,�
Title Association. IV
PECO MN' • ' ORS a ENGINNERS P. C .
( 516) 765 - b020
P. O. BOX 909 ELEVATIONS ARE REFERENCED ,
MAIN ROAD TO AN ASSUMED DATUM
SOUTHOLD , N.Y . 11971
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