HomeMy WebLinkAboutWells (3) 4FO[itr
JUDITH T. TERRY : ; Town Hall, 53095 Main Road
TOWN CLERK ® ' P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS
r Fax (516) 765-1823
RECORDS MANAGEMENT
RNT OFFICER
MARRIAGE
OFFICER *' •• Telephone (516) 765-1801
® 4111 11 °.
FREEDOM OF INFORMATION OFFICER ;� ��i3O
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1170 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GERARD AND JOHANNA WELLS
Address 1 : 775 LEGION AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION OF A CESSPOOL TO AN EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT WELLS
BUILDINGS, PROPERTY LINES, WATER BODIES AND MINIMUM OF 2' ABOVE
GROUND WATER. EXCAVATION INSPECTION REQUIRED.
Name Of Owner WELLS, GERARD AND JOHANNA
Mailing Address 1 775 LEGION AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 775 LEGION AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 142.00 block 2 lot 2.000
Cross Street FACTORY AVENUE
Building Permit Number Cross Reference:
Issue Date: 7/20/94 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
//)g, - - 5 ,„ f"
�`.�'G1 our/--
'16 J 4®
JUDITH T. TERRY ' L Town Hall, 53095 Main Road
TOWN CLERK :
=v r= : P.O. Box 1179
REGISTRAR OF VITAL STATISTICS `y �� Southold, New York 11971
�.. , Fax (516) 765-1823
MARRIAGE OFFICER ��'/ v��®I•`� Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER =701 1�
FREEDOM OF INFORMATION OFFICER ��,..rir�irrro
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD Q j y
'I u 1 9 1994
PH_'--
' :
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office BLDG DEPT
p roWN of SOUTHOLD
DATED: July 18, 1994
Transmitted herewith is a copy of application No. 1214 for a Cesspool/
Septic Tank Construction Permit submitted by:
Gerard S. & Johanna Wells •
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 EXCAVATION INSPECTION
REQUIRED
DISAPPROVE
.
Comments: M`- ,, , /7-% ,,,•,-/ ,
ai#(,ex_vvz zofea- , ,, _ , / ,z,y/ .
/ ir , i -
RECEIVED
......-------79--- .a../ ,:..--- /..,--7 rel_c__,
rJUL 2 Q 1994 Signator
Town Clerk Southold Dated / '
OFFICE OF THE TOWN CLERK ,,,,"""
Town of Southold e'" V01./(
Judith T. Terry, Town Clerk ��' �� ��l/ . Application No. /„2-..../.(f
Town Hall, 53095 Main Road Z :G Construction
P. O. Box 1179
v rn • Alteration
Southold, New York 11971 ctl
Telephone ‘y0,y Q��'� $10.00 - Residential
(516) 765-1801 l �� �
$25.00 - Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE —7—a--9
APPLICANT NAME: &Eki1:1-.4C6 --� 0 hia4 ( 6 S
APPLICANT ADDRESS: 7 . 0/J 74-L/�.
• r cic y /
SEPTIC CESSPOOL
DESCRIPTION OF ,PROPOSED CONSTRUCTION OR ALTERATION /MD/N
CYsooC
LOCATION MAP: ' Must be attached hereto before permit may be issued.
•
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: , J
OWNER OF PROPERTY: Se4g.,6 L 5.- —TO h4( ft) r/' E -LAS -
OWNER MAILING ADDRESS: 775 G86 to Al /Q-((6:.
OWNER PROPERTY ADDRESS: c/211j/JE
TELEPHONE NUMBER OF CONTACT PERSON:
TAX MAP NO. : Section / o� Block Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS RFERENCE:
•
/40.- 661681-
Signature of Applicant
RECEIVED BY: _ � �`"-''
T n Clerk's Office -
DATE: / L
100 \ 3 .c\
.y
OBER'( S, o .
& R A6' 0n� `s' o� Q°
$1008 1aT � O�
' Ip,R• IO ,� Z
, til0 - 0' s.. 0
1I• '0 - T
633 �
m' s �0 .
n
I �
u• '"S-
%.".
To I •x �N
i, Op `.
NP
13O
:� ' vi• `
2h' a ern{nC 9.31'�O
e{9� ',�•r S.560 0 2 73 ,
25' O
�L7i oil' - ?Pa Ia T 0
'9� �p o s uS tS)/3 ,�
•
''O 9.31x0• (J)o� 5.60• Z i ' s , `�• '—k
\ '
•
HT1
_ CERTIFIED TO, . I \ i? ` av � p,
JOHANNA WELLS _.—,_ Z o ,.3- x I0/ mss r�j:�3'b` " ,, �,
AMERICAN RESIDENTIAL MORTGAGE CORP. : ;�:�� ft ,
SECURITY TITLE & GUARANTY CO. `� tm�
oll
O '.•p •o. , 0' iiP
00 ,
7s. 60 0'- • a
SURVEY FOR
GERARD S. WELLS & JOHANNA WELLS
AT MA TTITUCK
TOWN OF SOUTHOLD ,
SUFFOLK COUNTY, NY.
1000- 142- 02- 02 _
• Scale: 1"= 40' AREA= 43,0'61 sq.ft.
Dec. 8, 1992 - .
. / , ,
/' `•1�eot.MF yOip,�
10 F,P
ea
tis , a
/
Prepared In accordance with the minimum 0W `-`1`� .S. LlC. NO. 496/8
standards for title surveys as established PE `fWr"{�` 'S, P.C.
by the L.I.A.L.S and approved and adopted (516/ , �EB&'
for such use by The"New York Slate Land P. 0. B ' '.9
The Association. MA/N ROAD
SOUTHOLD, N.Y. 11971
-
92-315