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JUDITH T. TERRY ; Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
Fax (516) 765-1823
MARRIAGE OFFICER y® ®. �
iyit �1� �� 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. 999 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : WARREN WIELT
Address 1 : P. O. BOX 66
City St Zip LAUREL NY 11948
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING
APPROVED AS SUBMITTED.
Name Of Owner WIELT, WARREN
Mailing Address 1 P. O. BOX 66
City St Zip LAUREL NY 11948
Property Address 1 MAIN ROAD
City St Zip LAUREL NY 11948
Tax Map No. section 125.00 block 1 lot 10.000
Cross Street LAUREL LAKE ROAD
Building Permit Number Cross Reference:
Issue Date: 5/17/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY Town Hall, 53095 Main Road
TOWN CLERK z ® % . P.O. Box 1179
REGISTRAR OF VITAL STATISTICS .gr -no
% Southold, New York 11971
MARRIAGE OFFICER __ 46, 0 ,„
, 40. 4,Nr- •' Fax (516) 765-1823
lik ' Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 13, 1993
Transmitted herewith is a copy of application No. 1027 for a Cesspool/
Septic Tank Construction Permit submitted by:
Warren Wielt .
Please review the application and locationmap 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.
•
d .
• Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following reco endations:
APPROVE
DISAPPROVE
Comments: __. ./.-.., s �. - --L__-/i
•
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Signature
Dated2 1 , 9 3
OFFICE OF THE TOWN CLERK c,\\rrOLr
Town of Southold
Judith T. Terry, Town Clerk rc r'; Application No./10, 7
Town Hall, 53095 Main Road c !�% ' =
P. O. Box 1179 Construction
Southold, New York 1 1971 1-,:'•53:, -
�"'� %`
Alteration
Telephone "°l 44 ' Residential
(516) 765-1301 /IT
Non-Residential
__
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT RECEIVED
SEPTIC TANK or CESSPOOL
- MAY131993
Permit No. Southold Town Clerk
Fee .$
•
•
DATE /3 /9(
9j
APPLICANT NAME:
APPLICANT ADDRESS: r'2
2 411/2 ,
SEPTIC /CESSPOOL -
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 0/4 f ,v
G%
OWNER MAILING ADDRESS: P® 8.
//9VR.
OWNER PROPERTY ADDRESS: .)7/27•
TELEPHONE NUMBER OF CONTACT. PERSON: 29'x`- 1.0664?)41�
TAX MAP NO. : Section /0 5 Block
® Lot /Q
•
CROSS STREET: •
BUILDING PERMIT NUMBER CROSS REFERENCE
•
Signature of Applicant
RECEIVED BY:
Town Jerk's Office
DATE: / 3 r 67_3
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SURVEY FOR
�, "A°''` �'�`"a�
bAN/EL WIEL T & CHRISTINE A. JONES
� , :.:,.w"._:�_-..._ .;3so3 AT LAUREL
s /,:,;c�`2 �/ ;-13'��'..:;'. 9 TOWN.OF SOUTHOLD
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��=rsi;.� �� , SUFFOLK COUNTY, N Y. �,�, r,r�a�,
11000- 125- 01- 10 di$-( p1 iff4
.`-XPiii1:S THREE YEARS FROM DATE c C. APPROVAL ,Y /
Scale: 1"= 40'
1u Mar. 10, 1993 APR 23 1593
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3. � /!..•���y�`�� HEALTH SERVICES•/
/)..'" ,,. . .S. LIC. NO. 496/8 -
41. • • Prepared In accordance with the minimum The locations of wells and cesspools
- 3ilj �i/ 3 ''-S, P.C. standards for tile surveys as established shown hereon are from field observations
15/6�<4./ 1s I by the L.I.A.L.S and approved and adopted and or from data obtained from others.
P. 0. :• -/9 for such use by The New York State Land ELEVATIONS ARE REFERENCED •
MAIN ROAD Title Association. TO AN ASSUMED DATUM.
SOUTHOLD, N.Y. 1197/ -4/9/93 .r c v.; ,
4/4,/93 pr.00 hse• 4•/Z74Pi aotot.f ... /t
- - 93-151 -
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