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JUDITH T. TERRY T Town Hall, 53095 Main Road
TOWN CLERK , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS :?� Southold, New York 11971
MARRIAGE OFFICER � ® �� Fax (516) 765-1823
-, i ® 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. 906 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : ESSEKS, HEFTER & ANGEL
Address 1 : RE: ESTATE OF JOSEPH WOGLOM
City St Zip RIVERHEAD NY 11901
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING AND SANITARY SYSTEM.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner WOGLOM, JOSEPH JR. ESTATE OF
Mailing Address 1 C/O ESSEKS, HEFTER & ANGEL
P. O. BOX 279
City St Zip RIVERHEAD NY 11901
Property Address 1 MAIN ROAD
City St Zip EAST MARION NY 11939
Tax Map No. section 23.00 block 1 lot 6.002
Cross Street STARS ROAD
Building Permit Number Cross Reference:
Issue Date: 9/18/92 Judith T. Terry
Southold Town Clerk
(TOWN SEAL 1
c inn
Se I
06�® TI
JUDITH T. TERRY , Town Hall, 53095 Main Road
TOWN CLERK ® •��� P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER ® /� Fax (516) 765-1823
r.-S-4! Fax
(516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 4, 1992
Transmitted herewith is a copy of application No. 930 for a Cesspool/
Septic Tank Construction Permit submitted by:
Estate of Joseph F. Woglom,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 �(
DISAPPROVE
Comments: il. q
ruhxa
1.► Q . u�l clt..
'NC
VS& C21)/2.-4.-"D
Signature
.1\ at\ck
Dated
OFFICE OF THE TOWN CLERKO `:
Town of Southold � OG 9,
Judith T. Terry, Town Clerk Application No.�(1Q
Town Hall, 53095 Main Road o ? ' =
Construction
P. 0. Box 1179 cs-3 ' titer`
Southold, New York 11971 c.A• , 1 Alteration
Telephone / 01 x e Residential VI
(516) 765-1801 " Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE , er ✓,� /1,2-
APPLICANT
//2APPLICANT NAME: A 447 ZJ
APPLICANT ADDRESS: d 7944-- ?
S.a
/ /Q- ,� L /'7 ,.rte ,q a s 277 ieNe ' ri/Y l/9o/
SEPTIC ' CESSPOOL J
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION CL) ve 7
'h Psi,/ ,1,,,: A I A `� . ,�1, .so►ni4/r?r✓aje714
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: '� o ' 0-ip 25- A/jA�
OWNER MAILING ADDRESS: % ep Mi 4' ,Q / 1 A ,'
• '. . /./ i. 277 :.'
OWNER PROPERTY ADDRESS: 4./.0)-71A sr4 ";41a (/)., , �® .T
ove / ;V /7c4H05 ivy
TELEPHONE NUMBER OF CONTACT PERSON: (VC)56'7—Mg
TAX MAP NO. : Section 023 Block
.2. Lot /
•
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:.
•
'0" ��--+SSi+ ig/�naturre o' Ap.licant /r./
RECEIVED BY: ---67 <��D� �` C�" 1, L1�0®//ham
Tovi Jerk's ffice
J
DATE: . "1" � - r
\ - w r
1L11 SUFFOLK CO HEALTH DEPT.APPROVAL •
ti9AP OF PROPERTY PLEASE MOTE L
_^ ,____10/0G1. '0 d (� cessaoats) S(12VEYF<a_F02TNE ESTATE-CF
I.,12.9'".1".„._ r"'--t E- F ` - '1f ---- i It i the applicant's responrlbility to
Pi( /1' : 1(yl•r ��1�C �'-� W;Jrl_�) alb, ma nt�:n adequate sanitary distance
":;11-,11::. m r!1 �.1;�3 betv,'E:r:ri well ' - bet ve€n all water supply and sewage
;:nd ...:cs po.11 i_, to be 1.O feet. .25 -f, 1 - A.i dis osmi ;acl',t,o� ,
+zj M G EAS[' r �fc1, STAT_EMEN,I.CtE,1P1I8tlTQ
r_ 50 c- 'F(1A ,-- THE WATER SUPPLY AND SEWAGE DISPOSAL
t�.08 _
cry 1 `go i ui ----- >"- ------ N.Y. . SYSTEMS FOR THIS RESIDENCE WILL
1 , it N CONFORM TO THE STANDARDS OF THE
k 5.--: zi SUFFOLK CO DEPT (OAF HEALTH SERVICES.
!• w I. O'-- (S)C/XiA-A JJt+ �•t 41l/�P.�4 r b_
in -� - - U APPLICANT
___i -- . u /�
t 1 �'°• \ , SUFFOLK COUNTY DEPT OF HEALTH
i I F2Gv Ci::'-"E ,\ '
- -- mop, 1�0 •t v
4 SERVICES — FOR APPROVAL FOR
;_i, '' - t / \ Y CONSTRUCTION ONLY
- ----.-x-:- j• �r �. v DAT:
' mac:— ! - _ - "- - aROP WELL �-•� 1 LD W r Un -_�_-
i I v:ELLt 1Y H S.REF NO. '=Z -3 _
f prop gcp-r. APPROVED , re '`A/ j
sol. Exert. - t '° —
1 i �/q s-/ y..%6(
y ` . - I.20- Ill �! SUFFOLK CO.TAX MAP DESIGNATION:
i__ _ so ".. • _ . ,�1 DIST. SECT • BLOCK PCL.
'`9
COOCJ 023 I 6.2•,
- s ,, 1' Et`NE'-OPE 1 000 O23 2 I `
r1 w f3s)1LDIIJCo - aL OWNERS ADDRESS:
•
a _ (1. N THE ESTATE OF JOSEPH F CIGLOM Jil
1. T.H 5, U) oS So S i
tr t,; 7 -�6 _ i PLEASE NOTE yo es5 E!C5 tiEFTE2 4 ANGEL `
+9_ - - ' �anitary system is not to be LOB �,MAIN s
PO.1X/X-279_
a 69.69 r,iZC:,�1.' r i
placed under driveway area. rzly.st_'�tAc,_r�Y__119pt b9�!-roo}
,t+ ' 2hC.225-9 C' I - 66 / DEED: L.6235 P.289 C 2EE)
,r ^� TOul940 T�. 2 • 1 �ALE•S`J`i
TEST HOLE ' STAMP
ra014-C•' e, ! I E -MQN(J?+'lENT- ETI �ATIM ��'TECTI I .11EO PLED
���m 1,1110 N '�ATE ' AIZEA(N.OF TZOA.D)'.,9,327 s.F LAC.sROw>u
~ LOI3Cr2.se.A ALIS -- -- -
W #rr
SANDY LOAM 6' ,- r•„ _4,r.�•h•t„
!L �_ .t�. r �. BROWN
—
_ 'A� 7TH.. - ..1==L- rL-I 1_.1.1--�1.- /,re.s.15 •7 , ..J^^.17+Oe3O E.. -_..__ . . •-...ve,in{:P•.iG
_. -r r LOAMY S/.ND -z-1 rhsF:rn[M CC4,4':err!
- -\�,f h170'19 -at E. .7.1-.0�2: I FILL 22.0 cLd srno cr0/.
7�S) "Roc 14 WATE inA¢v_ 13RCiWN •I "„•..•t"dhoreanrS•'1r,'^
^2D1 t,SartY NIG :LRYEY SANG i '-'=on 4nrsarhr s'•a -,
. WATER: II.: _. `:'r h ,
RI ENT '-IAR8OC2. 82owN • dr c
MAP AMENbED A PR,28,1992 CLAYEY Sq.1D !.,1.•a a Cr s.I:c Z. -
T�
SINGLE FAMILY DWELLING ONLY `�'^r+itu SEAL
EXPIRES 3•
YEARS FROM DATE OF APPROVAL C�Y>:Y .`o
<EFECc I% MEAN SEA. EvI+L,N.Ca.V O. }� wA ez 1n1 IO If.t �n''�'`',AS SiJ2VEYED FC•f0( C BROWN - ° •:.„ ias'4' • i
' - ROQ.fRIC�K VAN.WYL.P C. - PINE To- 'I '' r i.r
r •
+JEG,Y HEAVY \o �S'Z5°ry /-r.
• " LICENSED LAND SURVEYORS 1 04AVR(. 16' -
GREENPORT NEW YORK ,