HomeMy WebLinkAboutFriedberg, M Paul (3) - ���OFFOUr -
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JUDITH T.TERRY 4 Town Hall, 53095 Main Road
TOWN CLERK = P.O. Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS ;%4A,_ l.. Fax(516) 765-1823
MARRIAGE OFFICER = 1 �a���� Telephone(516) 765-1800
RECORDS MANAGEMENT OFFICER l [ �s°
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. 1406 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GENDOT ASSOCIATES, INC.
Address 1 : P. O. BOX 847
City St Zip WADING RIVER NY 11792
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. #R10-95-0121
Name Of Owner FRIEDBERG, M. PAUL
Mailing Address 1 1000 SPRINGS FIREPLACE ROAD
City St Zip EAST HAMPTON NY 0000
Property Address 1 SELAH LANE
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 9 lot 4.007
Cross Street COX NECK ROAD
Building Permit Number Cross Reference:
Issue Date: 10/27/95 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
l/olc)
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to$ �O G .
JUDITH T.TERRY • Town Hall, 53095 Main Road
TOWN CLERK y Z ; P.O.Box 1179
��� Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 1 Fax(516)765-1823
MARRIAGE OFFICER y� a���of
RECORDS MANAGEMENT OFFICER _-re
�► ,, Telephone(516)765-1800
FREEDOM OF INFORMATION OFFICER i"OP 5 j1 r
OCT 2 0 MI5 L
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD ____.
4 ,
Town_;or 1 5-Hr1
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 19, 1995
Transmitted herewith is a copy of application No. 1458 for a Cesspool/
Septic Tank Construction Permit submitted by:
Gendot Associates, Inc. for M. Paul Friedberg
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 L/
DISAPPROVE
Comments: t ` '4g).A,/
Signatur
r
Dated
OFFICE OF THE TOWN CLERK ,,,,""""'•,,
Town of Southold �.'.'����FO���+O Application No. l
Judith T. Terry, Town Clerk .t' Gy
Town Hall, 53095 Main Road �,' Construction
P. O. Box 1179 � � ' 'm .
Southold, New York 11971 tt� yc , Alteration
$10.00 - Residential
Telephone
(516) 765-180114141 ' $25.00 - Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL,
Permit No.
Fee .$ •
7� G+
DATE te-e l� �! 95
APPLICANT NAME: /‘/C1‘414244404?--e.....).
C
APPLICANT ADDRESS: / J1' d'47
/171a
SEPTIC 1/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
foo iU seek, ,depdaZ g i X/7. ,Getr;
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /f1 ��Uh f,6/51 ?6,e6.
OWNER MAILING ADDRESS: DOD ‘.P;v2:€.474_-)
OWNER PROPERTY ADDRESS: ( } t+ .11,-)
rri }.�
TELEPHONE NUMBER OF CONTACT PERSON: 9a 9-- ��3/Ov jo?9
e '"6y�/
TAX MAP NO. : Section g/p Block 9 Lot 9, 7
CROSS STREET: 6-7k ► --� Of,
BUILDING PERMIT NUMBER CROSS REFERENCE:
i , -/ 37>, ,e41 , 9. L ,)
f ignature of Applicant
RECEIVED BY: ,
To 'n r erk's Office
DATE: /o (ar -
.
SUFFOLK CO. HEALTH DEPT.APPROVAL'
• H.S. NO.
LiOPEr2. 1 AGRIe-ULT'.:IAL QESET2VE EASZN•4`..-: iT' AIZEA
!
- (VACANT) - •
_221.44 u'A.% ter- ?r= `,j''',1:27-','. i
s.71.570Q"E. _ -_ t
:.)UiVEYED r02
— -- STATEMENT OF INTENT
PtZCP.WELL ' ^t'-i\ 1{•'.1!..-\, '� .. '^ (2.„(---,,---1 ' T .` !f THE WATER SUPPLY AND SEWAGEDISPOSA_
L 1
O 2EB tB r'''-'c'-'•\•.,
+�I� , r +- I • ��_ SYSTEMS FOR THIS RESIDENCE WIL_
N �� ��l � � u IN.iv AT CONFORM TO THE STANDARDS OF TH:
u7t�i��i�#, ��J ' —_ — ! SUFFOLK CO. DEPT. OF HEALTH SERVICES.
ltl �o- MATTiTUC':� (5)
-
APPLICANT
�- Tcv :F SQUTh-(CLD , NY.
( SUFFOLK COUNTY DEPT. OF HEALTH
- / I I SERVICES - FOR APPROVAL FOR
' 1' 1 CONSTRUCTION ONLY / /
i /0/6'45-
\
o /6 9S
4 AGMe`; DATE:
(VACA►.IT) PROP.SEPTIC SYSTEM. r-C ?--- NO. '' ` V H.S.REF.NO.: �/O-9S D/L�
900 GAL.3EPTIC TANK, FL
EL-44- 7
S��y12�CESSPOOLwITH 1st• • APPROVED:
50Z, wr.ExPN, � '�
i
8 .--.<_
, SUFFOLK CO.TAX MAP DESIGNATION:
�O` `� _" e...`11 N N DIST. SECT. BLOCK PCL.
Z sb - v c ;` I ( 1000 106 9 4.7
�- p 1 215n TO CHIT-OFF AT COX NECK RD -- ,`, j
l OWNERS ADDRESS:
c--.5°-° c 1 N.-7 Iao w-1.69
P.3.aOx 7
/ P 8/ip. 11 ?6•44" ' \. '`,`\` WADING IVER,NY•1179
-LANE ' •
SgLA-A 1 TEL-929-q3!C
1
DEED: L. NVA P.
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ASE =t' \ I I .d.»"�° a..
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7 ''� 'f I a..a.. '--t.-'1'
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(VACAN`) _.1 i I m. :::
d1 ; 1 '. :ate' NTOU125REFER 1T MEAN SEA LEVELL IGVD, ! bi0°"�"'"'°"" w��(VACANT) - iN ,a.,.15.l , i EL
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[SWT i; 1 f I I N I ��OFEcy'LOT NO.S_2EFEI2 TO \n1EST MILL SLIBVIVISiON ` it�, ti I w I �� `` crA��
iZT`� .1ia:V Yc 2 L F _.. t CI ; ;* o._ 1*
PCZAPE SI F p � ALL '-^9E tv, AS SURVEYED 1.?.CT 5 ;995 j I to * ¢ i*'
`cy •F•••• T ,E LIF w. CC :FF!CE AS mAP NliSEO. nes 11 i % !
___ — _ RODERICKVAN TUYL.P.C.
S.C. DEPT.OF LICENSED LAND SURVEYORS '""
HEALTH SERVICES GREENPORT NEW YORK
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