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HomeMy WebLinkAboutWorth q'a SI,„,„ /iii���fi MLA- JUDITH T. TERRY ',s' s Town Hall, 53095 Main Road TOWN CLERK z ® w 14,-4 t P.O, Box 1179 , Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ;��` Fax (516) 765-1823 MARRIAGE OFFICER pr7 ��� Telephone (516) 765-1801 RECORDS MANAGEMENT OFFICER _ ?1j . til' FREEDOM OF INFORMATION OFFICERsy� �'�� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1251 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : EDWARD AND CAROL WORTH Address 1 : P. O. BOX 2094 City St Zip AQUEBOGUE NY 11931 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. #R10-94-0100 Name Of Owner WORTH, EDWARD AND CAROL Mailing Address 1 P. O. BOX 2094 City St Zip AQUEBOGUE NY 11931 Property Address 1 BALDWIN PLACE City St Zip CUTCHOGUE NY 11935 Tax Map No. section 103.00 block 10 lot 2.002 Cross Street STROHSON ROAD Building Permit Number Cross Reference: Issue Date: 11/25/94 Judith T. Terry Southold Town Clerk (TOWN SEAL) „ ,,,,L7,...,.i. ,4,' ®� JUDITH T. TERRY ° ” =a Town Hall, 53095 Main Road TOWN CLERK - ,.-14"'x` A P.O. Box 1179 REGISTRAR OF VITAL STATISTICS .' iM " 'e w `' Southold, New York 11971 y '. � i'' Fax (516) 765-1823 MARRIAGE OFFICER �' 441;., -:,,. �� �, Telephone (516) 765-1801 RECORDS FREEDOM OF INFORMAT ON OAGEMENT F �II OFFICER ������� o' OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD "; , fig) [ j TO: Southold Town Building Departments i NOV 2 3 1994 LIL.„..r_____ ) FROM: Linda J. Cooper, Southold Town Clerk's Office s.........i DATED: November 22, 1994 TOWN OF SOUPT Transmitted herewith is a copy of application No. - 1297 for a Cesspool/ Septic Tank Construction Permit submitted by: Edward and Carol Worth • 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: ,f...• C�� / do •` /0- 9 ®© ®-0 / •• • -" -----",---;?"--7: --.1 - Signat e Dated '•- OFFICE OF THE TOWN CLERK ; (-,- Town of Southold ���rr��'� �- Judith T� Terry, Town Clerk C' " ���~ Town Hall, . ;c� r: �„ y 53095 �\Iain Road . i.- �"• :,_ ----- ,_ Const cacti No. 4.--2 97 Judith :r P. 0. Box 1179 cr1 tom::% Flft; '` Construction ,-� /Southold, New York 11971 Oc- Alteration Telephone �l � yb 1c4 (516) 765- 1301 �{ Residential Non-Residential• TOWN OF SOUTHOLD . . SOUTHOLD WASTEWATER DISPOSAL DISTRICT • • • APPLICATION • for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee $ • • DATE 7//9-c /F . APPLICANT NAME: .E Dw ,4vo CAW/ u27-W- APPLICANT ADDRESS: - Os 60Y 2 o y • Qh- 60 i N /7 5'3 • SEPTIC CESSPOOL - DESCRIPTION OF PROPOSED D CONSTRUCTION OR ALTERATION LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: /p�,4-4-• ' OWNER MAILING ADDRESS: P"0- eoxc 209/ • ilait60, fa //9. / OWNER PROPERTY ADDRESS: Ga4N-c2 • 64-Lowry c-,7112 04 Suns i '().40 _ CU-ICI-10 ac.) E - TELEPHONE NUMBER OF CONTACT PERSON: ; k- ,..5-14, 7.34e— zcf— 73 TAX MAP NO. : Section 3 Block J_________0 7 Lot 2• Z CROSS STREET: /-1 -t--1- LE N �e BUILDING PERMIT NUMBER CROSS REFERENCE:- • / „ - `�/�iatui e of Applicant • RECEIVED BY: / own Cleric's Office DATE: /7 7-2--z- C SUF- � SEPT. APPROVAL c� ePOOL r 21 1994 1,Gait\ -1✓ -WELL) i ;� i , \ _ S C. DEPT. OF p T� �F Verr ' • 1 ( 2ES a I SFTATEM3N7EOF INTENT i r !� ! I j THE WATER SUPPLY AND SEWAGE DISPOSAL 1 S3'- ®Q i SYSTEMS FOR THIS RESIDENCE WILL �, 0 W CONFORM TO THE STANDARDS OF THE J I I SUFFOLK CO DEPT OF HEALTH SERVICES. I I 5.S4 54 20 E. 0 259.90 1 ....1 0 (s)sAPPLICANT er j , PLEASE NOTE J Cl) SUFFOLK COUNTY DEPT OF HEALTH 1 r Minimum distance between Well uJ O _ 2ES, 1 W SERVICES - FOR APPROVAL FOR MAP OF PROPERTY } CONSTRUCTION ONLY 1t' Z' • and cesspool is to be 150 feet. -. n' i -J w DATE SURVEYED FOR 1 p 1 H 5 REF NO. ��A �� �� ��`\ , /! t — .. ./_/`_ _ jI �1� f/'!'�) �— .t[ s 1------ �� I APPROVED /•¢_ !/ Y`J/ . v /�. �_/� VV �J �Tl } Pcz4P-wE�! 2� 11! ; ` CO al 0 CC ATi 2 1 1 , SUFFOLK CO.TAX 0 LSIGNATION. — V IP Z 1 y W i DIST SECT. BLOCK PCL. EAST CUTCNOGUE \ _ _ - _ a fl toC0 103 10 22 TOWN OF SOUTRO`{; N.Y. \ . GAR.; Q 3 I OWNERS ADDRESS. :Tz\ P.0. 2094 1 AQUEBOGUE,N`1. 1193! \,,\ i PROP 90 — r I i� • L_ I --- WELL VACANT) u, z- __ _I Ui 722-.5120 i in Z a J - 1 N RES { I DEED L. P z0 I I TEST HOLE STAMP 1I ( ` ----- - - -2--fO I -Nt.:-..:.,:11:.-.17-/c.-; - , '.:.E� Z� IF 150 - .j t. /, ;I I i, h I 4yt, c.u:s'._d You Sttu'� - 1} [41 a• �p' it:-. F N i - - - ---- DK•LQI�ROWN . , 1 p.' l7i CILto I __ 10 c '1..-;cc:W=:.;:.^_god 11 _� o N I gr. BROWN wt,a s nsapy. SCALE-60•l' �' 3 { SANDY fa: ca:t+c,rer, 1.1 1:y .;Dr nnrt,'0 ` Ln LOAM 2,6 AREA=2.0A1C. 1 1 -- X215�S — `t'- `° / I o 13 N 1i` ' _, 1ar,a 0 =PIPE -1-1— TO TEST HOLE 7 i V 1 �? CUIYEYSld�1Pl 1 - I i - 185' TO - { GRADING i tc, - - - - TO CLAY GI, BALDWIN C2t-i=k. 4.5i .— • N-84544 201W I 259.90 I ;` +�j SEAL _SO BALDWIN PLACE a PAtE, NOTES 1 i 7 BROWN I,LOT NOS.REFER TO A MINOR. SU6DLV1510N t N — ----- — r--t COARSE J MAP MApE FOR_MA_OON �E5114S. _ ..C1 + a A5 SURVEYED OCTI5.19g4 SAND Z.CONTOUR & ELEVATION 2EFE2 TO MEAN SEA LEVEL. 2 ROD RICK VAN TUYL,P C G., _.—._.__—_.— _ - --. - — . __-..._.T- N G- - i. ,may �n n `I N LICENSED LAND SURVEYORS 1T' ,-:�g.'f''", - 4 GREENPORT NEW YORK