HomeMy WebLinkAboutFrederick Mary Ellen ,/ oil OFFO(j►co
JUDITH T.TERRY `� Town Hall,53095 Main Road
TOWN CLERK y Z 1 P.O.Box 1179
117 1 Southold,New York 11971
REGISTRAR OF VITAL STATISTICS % ,L ! 01 Fax(516)765-1823
MARRIAGE OFFICER .4 a� , Fax
(516)765-1800
RECORDS MANAGEMENT OFFICER 1 * �►
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. 1293 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RIVERSIDE HOMES, INC.
Address 1 : P. O. BOX 274
City St Zip RIVERHEAD NY 11901
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. #R10-95-0017
Name Of Owner FREDERICK, MARY ELLEN
Mailing Address 1 C/O RIVERSIDE HOMES, INC.
P. O. BOX 274
City St Zip RIVEREHAD NY 11901
Property Address 1 GLENN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 1 lot 23.000
Cross Street GRISSOM LANE
Building Permit Number Cross Reference:
Issue Date: 2/27/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY : Z Town Hall, 53095 Main Road
TOWN CLERK : p eZ P.O. Box 1179
tri W $ Southold, New York 11971
REGISTRAR OF VITAL STATISTICS �. ,' Fax (516) 765-1823
MARRIAGE OFFICER ‘'''104,A._ ' •1 ,$. Telephone (516) 765-1801
RECORDS MANAGEMENT OFFICER ---.. -J � * .'
FREEDOM OF INFORMATION OFFICER �,,,,,/////,�/
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD i[ h
!-------L—___�.-
TO: Southold Town Building Department FEB ;' J 1995
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: February 14, 1995OFgoTtlO .T
Transmitted herewith is a copy of application No. 1340 for a Cesspool/
Septic Tank Construction Permit submitted by:
Riverside Homes, Inc. for Mary Ellen Frederick .
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: �C477- 2 C!5 i p O/ 7
Signa ur471-
. 2-,*-7/5—
Date
OFFICE 'CIF THE TOWN CLERK �/
Tor) of,Southold Application No.1 / 0
Judith'i r Terry, Town Clerk Construction
Town Hall, 53095 Main Road
P. O. Box 1179 Alteration
Southold, New York 11971 Residential
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
cONSTRRUECI 'DALTERATION PERMIT
SEPTIC TANK or CESSPOOL
FEB 141995
Permit No. bouthotd 'town Clerk
Fee $
DATE 1/24/95
APPLICANT NAME: RIVERSIDE HOMES, INC.
APPLICANT ADDRESS: P.O. Box 274, Riverhead, MY 11901
SEPTIC x CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
construction of a single family dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : Mary Ellen Frederick
OWNER MAILING ADDRESS: c/o applicant
P.O. Box 274, Riverhead, NY 11901
OWNER PROPERTY ADDRESS: els Glenn Road, 358.04' w/o Grissom Larie
Southold, NY
TELEPHONE NUMBER OF CONTACT PERSON: 516-727-3395 ' "'
TAX MAP NO. : Section 78 Block 01 Lot 23
CROSS STREET: Grissom Lane •
' BUILDING PERMIT NUMBER CROSS REFERE CE:
ignature of Applicant
'•rdon, President
RECEIVED BY: - 1
own Jerk's Office
DATE: 11/41. � �
D
l`, 7 ' nrE vQ c a ANY AL 7ERA TI�?N OR ADDITION TO 77IS SURVEY IS A VIOLATION •
N N/�/ The locations o/ wells and cesspools C OF THE NEW YORK STATE EDtKA77bw LAW,
7` F shown hereon ore from field observations HEREEYCEPON AS PER SE FOR 715 MAP 2. ALL CERTIFICATIONS
hEREON ARE VALV FOR 7795 AAD COPES THEREOF ONLY Fc
9 1995 HOSE SGHATURE APPEARS frEIREOM
_` S 7S• Of 0 and or from data obtained from others. sWAry appSEAL OF THE �y�
O «we ,
hem c --W 2s,3 9`�O-E ART ,Y� n4 ADDITIONALLY TO COMPLY WM SAD LAW ME Tow ALTIZRED BY'
WI 9 isw ( - C c o ELEVATIONS ARE REFERENCED All/ST BE USED BY ANY AAV ALL SURVEYORS WILLING A COPY
WNWr �c TO AN ASSUMED DATUM 'B -ANOTIER SPATE-ARE IN COMPLIANCE WITH VEYOR'S MAP. TIMMS SUOI AS 'A�
//000, �'f',
SOT O 31 /�a
<-'4_zZ
`�� 0 A'Po
£QT
/Or op SURVEY OF
A a' T 5y3,e, 8, o DoLOT 36
f lZ o "WEST CREEK ESTATES"7 ti O FLED AUG 19,7963 MAP NO.3848
pec , j6u. a - ,. Y i3� AT SOUTHOLD
. a TOWN OF SOUTHOLD
"`"5.5.41 SUFFOLK COUNTY, NY.
4 1000- 78—01 23
v00
t " AREA =23,100 sq.ft. :. Scale: 1".= 30'
Jan. 3, 1995
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C zit _�• CERTIFIED TOS
tS c 3 '16141
JOHN D'ALESSANDRO
CATHERINE D'ALESSANDRO
�1v ¢
sofa, M� ''`,47
Q USDA FARMERS HOME ADMINISTRATION
11 O�A 'a.oMs; Well
• f' V SCT/C, ANC.
�1<'(-1-4°
tea. h 0 I am familiar with the STANDARDS FOR APPROVAL
O - AND CONSTRUCTION OF SUBSURFACE SEWAGE _
>.:n.) DISPOSAL SYSTEMS FOR SINGLE FAMILY RESDENCES
N. �••••09,
p- oQ and will abide by the conditions set forth lher.ln and on the
W Qrw'J permit to construct.
vJ
`E�- //000 a Sra ,.
I An' 358,04' :--" .9 ,D \
'f''oc , SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
FOR APPROVAL OF CONSTRUCTION ONLY 'i
a
/', a
/ Y.S. LIC. NO. 496/8
---- =� 5 R040 I SATE E61 Q 1Ns. Rte. No. X10— _—t•. PECON/C* QRS, P.C.
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�/ (5/61 76,51______,t-'': :v s
�- } CL3 / P. O. BOR909
o 2/7/9S (i. /ic Sy 314-c,..,', j MAIN ROAD
So"w 1 APPROVED
//?3/95 ,badge i_ SOUTHOLD, N.Y. 11971