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JUDITH T. TERRY =
` • "4 o Town Hall, 53095 Main Road
TOWN CLERK " � P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ,
MARRIAGE OFFICER4 Fax (516) 765-1823
® � 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. 684 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : F. P. VERMAELEN, JR.
Address 1 : 212 BEAUMONT COURT
City St Zip RIDGE NY 11961
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 2/27/91 .
Name Of Owner VERMAELEN, F. P., JR.
Mailing Address 1 P. O. BOX 315
City St Zip MATTITUCK NY 11952
Property Address 1 BAY AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 140.00 block 3 lot 40.003
Cross Street RILEY AVENUE
Building Permit Number Cross Reference:
Issue Date: 3/20/91 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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MARS 9 19F:1 1 I : FEB 2T
I'' , Toy 'all, 53095 Main Road
T ✓ , �,' (se BLDG. DEFT. 1'.0. Box 1 179
- y `,.;TOWN OF SOUTHOLD
- au old,' New York 11971
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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: Southold Town Code Enforcement Officer
From: Linda Cooper, Southold Town Clerk's Office
Dated: February 27, 1991
Transmitted herewith is a copy of application No. 704 for a Cesspool/
Septic Tank Construction Permit submitted by:
F.P. Vermaelen, Jr. •
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 D�
DISAPPROVE
Comments:
ctro..491 , fly% a-1\N o
\COdv.4.
Signature
3\>>\t‘ ,
Dated
OFFICE OF THE TOWN CLERK , ,'""
Town of Southold ,'' , \VOLir
Town Clerk � C Application No. -2;4 Judith T. Terry,
Town Hall, 53095 Main Road Z Construction 1/
P. O. Box 1179 c 1-11Southold, New York 11971 : td1 �,� Alteration
Telephone =O,y ®T $10.00 - Residential
(516) 765-1801 (41 41 �, " $25.00 -Non-Residential
.�/N$,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.-7 6 `(
Fee $
DATE 2 77f/
APPLICANT NAME: G /�Ii CLQ`moi c7->r
c/
APPLICANT ADDRESS: O� ✓ �����i "-fry
SEPTIC ' CESSPOOL
DESCRIPTION OF
PROPOSED CONSTRUCTION OR ALTERATION
6S,-Af e,ci io R/
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: /�. • /gd
7~/ TZ/ c '0 V //9
OWNER PROPERTY ADDRESS:
TELEPHONE NUMBER OF CONTACT PERSON: 04-2 / -
TAX MAP NO. : Section /f,- Block 3 Lot •
S1D, 3
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signature of Applican '
RECEIVED BY: dr, ,ca
ryT ergo Clerk's Office
DATE:
FEB 27 T9
7oK
� -t••rt PLEASE NO;�•• `,-- - SINGLE FAM LY DFLUNG ONLY '
•
• �' �' EXPIRES TWO YEARS FROM DATE OF APPROVA .
It is the applicant's responsibility to
maintain adequate sanit ry, distarl,e
betwq�n all wafer supply and sewa�e i I. .
—N— e E ,d 1poSa! facilities. •i.; _
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=•�f�41s11tJ : llkui tl,TlUti REaUIRE1J SURVEY FOR _ •
L..- FRANCIS P VERMAELEN,JR.
3UfW3LIt'LO�TY DEPARTMENT OF HEAETH S>?�',,.=.. `
Nig;::4.
- JAN 241990
FQ4t./P VAL OF CONST3UCTICN 0; LY AT MATTITUCK DATE NOV.NOV 7,1989
m _ TOWN OF SOUTHOLD SCALE I 50
DATE-_" 7 HSREF. NO. ��,c' i SUFFOLK COUNTY, NEW YORK NO 89-1154
y.y�,l ��,_� `\ +UWUTMORIZ[0 ALTERATION OR ADDITION .TO THIS - A .
APPROVE 1/ ,, 11�J1 I -/<T�/ \7/ C ! SURVFT ISA VIOLATION Of SECTION 7209 Of THE E OF N
NEN TORN STATE EwcArloM LAw p� Neil,
3 L I) "' ,-2-\-- - •COPIES of THIS SURVEY NOT II(ARMG TM( LAND SN R0 w }O�
SUR VE TOR S INKED SEAL OR EMBOSSED SEAL SMALL *I` jO - 'I•'
NOT SE CONSIDERED TO BE A VALID TRUE COPY
■GUARANTEES INDICATED HEREON SMALL RUM ONLY TD ? I G
HEALTH DEPARTMENT-DATA FOR APPROVAL TO'CCW STRUC T 74E PERSON FOR WHOM THE SUPNEY IS'PREPARED Z •
AND DN MIS BEHALF TO THE TITLE COMPANY.GOVERN- c{�.L-` 0 `
• WATER WAIN WI _ M SOURCE OF WATER PRIIAT(_PUMLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED ■�jw�, *'
R SUFI CO TAX MAP DHT 1000 SECTION 144 BLOCK L LOT 40.3 HEREON,AND TO TME ASSIGNEES OF THE.LENDING \ �^ •
MTNEM ARE MD DW[LLIMS WITHIN-10O FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE MOT TRANSFERABLE '
OTHER THAN THOSE SHOWN M[R[OM ,OO-A
TO-ADDITIONAL INSTITUTIONS OR SUBSEQUENT ',
M THE WATER SUPPLY AND must DISPOSAL SYSTEM FOR THIS RES ID[NCE q{��
WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY D[►AR TMEMT MDI]TAMC[] SHOWN HEREON IRON PROPERTY LINES
ktrw�•c„i 5•'W
Of HEALTH SCTNICES TOF:13TING STRUCTURES -IRE FOR A SPECIFIC 01'
APPLICANT, _ PURPOSE AMD ARE MOT TO BE USED TO ESTABLISH •. LAND SO
PROPERTY LINES OR FOR THE ERECTION OF FENCES ,
ADORERS - -
—
TEL --- 4,.:' '''- YOUNG a YOUNG 400 OSTRANDER AVENUE
0` ;, RIVERHEAD,NEW YORK
NOTE ■=MONUMENT STAKE - • . LATH SET .I_ - - - - .
RE LOT NO 3,MINOR SUBDIVISION FOR ESTATE OF MARIE"A. - -- • ALDEN W YOUNG,PROFESSIONAL ENGINEER -
VERMAELEN AND LAND SURVEYOR N YS UCENSE NO 12845
•TNL'OCrITTaHOreLLfr)•SEPTIC TAHRIfT1•E(faiDOLs(ol worN WERE Cul - HOWARD W YOUNG, LAND SURVEYOR ,
NYS LICENSE NO 45893 I
•RE PNOr FIELD OWW[LIWI SMS MOOR DATA C5IRD[D IRON OTHERS
-
BRANDIS //SONS INC. - ,
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