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HomeMy WebLinkAboutGoldsmith, Clifford I ,, ... ., JUDITH T. TERRY � Town Hall, 53095 Main Road TOWN CLERK t p T P.O. Box 1179 REGISTRAR OF VITAL STATISTICS Southold, New York 11971 MARRIAGE OFFICER Q Fax (516) 765-1823 1D� �� 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. 1099 R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X PERMIT ISSUED TO: Name : CLIFFORD AND DOREEN GOLDSMITH Address 1 : P. O. BOX 261 City St Zip EAST MARION NY 11939 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. #R10-94-0012 Name Of Owner GOLDSMITH, CLIFFORD AND DOREEN Mailing Address 1 P. O. BOX 261 City St Zip EAST MARION NY 11939 Property Address 1 TUTHILL ROAD EXT. (LOT 44) City St Zip SOUTHOLD NY 11971 Tax Map No. section 55.00 block 6 lot 15.005 Cross Street ORIOLE ROAD Building Permit Number Cross Reference: Issue Date: 3/10/94 Judith T. Terry Southold Town Clerk (TOWN SFAI ) C.----c:---, 40. O , t%" JUDITH T. TERRY I` Town Hall, 53095 Main Road TOWN CLERK : p r= : P.O. Box 1179 tr * Southold, New York 11971 REGISTRAR OF VITAL STATISTICS ‘V,0, ,' Fax (516) 765-1823 MARRIAGE OFFICER ya� 1� RECORDS MANAGEMENT OFFICER :�'�1 1 ��1, Telephone (516) 765 1801 FREEDOM OF INFORMATION OFFICER �.....,.//////i, OFFICE OF THE TOWN CLERK f � (G i �`` TOWN OF SOUTHOLD c tki MAR 3' IL TO: Southold Town Building Department ;a g FROM: Linda J. Cooper, Southold Town Clerk's Office I - ^. DATED: March 2, 1994 Transmitted herewith is a copy of application No. 1136 for a Cesspool/ Septic Tank Construction Permit submitted by: Clifford and Doreen Goldsmith . 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 lY DISAPPROVE Comments: Sc, �, , , /llir • / �/Al 2. ..e.(,(/- . /It' ..,,fri Signature Ale Dated 1001044411 1 O*b Goo., i ,i "-A... OF'=ICE OF THE TOWN CLERK cjv�FUL4 Town of Southold �O- . Application No. // 3C Judith T. Terry, Town Clerk -F. �•c Town Hall, 53095 Main Road a Construction �� � P. O. Box 1179 0 . . '$ Alteration Southold, New York 11971 *0 0-.. , Telephone _ [ Residential J (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 $/©. c DATE ag 12Z- I q 6/ APPLICANT NAME: Ciicc .,1 J 4-Pov-e e v,) 60f 5ini'k APPLICANT ADDRESS: P 0. /viv 67101 X61 isliariaru ,W N //13? SEPTIC CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION iti5+11 i l - or i • , . e5S t. . i . , ; Cbw5iry c4-0 pus e , LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: Ctt ,r3.r01 c- Dni e„V 60/45 nil-h OWNER MAILING ADDRESS: p,6, Y Zta 1 Cas I- (ltlAelovv 04 1173 OWNER PROPERTY ADDRESS: 1—L t ii i/ pri &yreit.siett/ TELEPHONE NUMBER OF CONTACT PERSON : TAX MAP NO. : Section 6—jS— Block (, Lot /6-IC CROSS STREET: (J Le Priv e BUILDING PERMIT NUMBER CROSS REFERENCE: / ` � ;� t� � f nat re of Applicant RECEIVED BY: (-) L{) To n Clerk's Office DATE: 37y • • r� ,I. / • v� L ;s9 tEli ; •it ^7 ;,,11:, ! - R'40p1' i 0 vio('`' s •� 4.c "Ta y o \ / K> O vs17.F v SJ` 9m1? O \ 1_, --I., \co.0 IPG ‘9. (IP% v** , ST 4A O• , '0• \1 7/� S 2a P0�'I'/n �� G6 ‘� �. X00 t;• ,,, J t,\ m;' C:ii2. a. ,t� za' 2O el, t- ,`� s G,, i IP / Gi sgY.a., e.�4�'5; 9. Q/,..:7 Q • ,I- -t Jo1AC Y•yb� S tomA. 4 {� .G•C 0 -i -/O •\�62 A3 •\ �3\\ e� O0O 1•• PO o ti --' �9 • X94 -1��A\ . �• N ..- O f FQO, 'l• oo �o‘, To 6 2O t0<O oei /y o �' 05 0 d1 �o <e 6" .4. o< 0° O\ 1.'e ho •9' bO •c� `6 e<\i• J< 'co- , O< a<S / eJG "AU. T QL i SURVEY FOR CLIFFORD GOLDSMITH a DOREEN GOLDSMITH SUFFOLK COUNTY DEPARTMENT Of HEALTH sIRVWLt. .LOT NO. 44, "HIGHPOINT MEADOWS,SECTION THREE"MAR. 3,1993 OCT. 10,1990 AT SOUTHOLD DATE: JULY 25,1990 FOR APPROVAL OF CONSTRUCTION ONLY TOWN OF SOUTHOLD SCALE I"= 40' FEB 1 91994 /I/ 4,L SUFFOLK COUNTY, NEW YORK NO. 90-0541 DAT HS REV. N '.--. •uNAUTHORI2CD low ow*ow rlot. To THIS GUARANTEED TO: SURVEY O A V10LATION OF SECTION 7209 OF THE CLIFFORD GO I NEW YORK STATE EDUCATION LA• � ApROVE R COPIES Of THIS SURVEY NOT BEARING THE LAND T CORE TIT��• SURvEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL Y/' NE ��, NOT B[CONSIDERED TO BEA VALID TRUE COPY BRIDGEH• I, ••.JON•g •.• *GUARANTEES INDICATED HEREON SHALL RUN ONLY TO HEALTH DEPARTMENT-DATA FOR APPR0 L TO CONSTRUCT TME PERSON FOR WHOM THE SURVEY IS PREPARED (4( '2 . •NO ON HIS BEHALF TO THE TITLE COMPANY.GOVERN- -L R WATER GAIN NI I *SOURCE OF WATER MATE—PUBLIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED Itis:*.44 a MIF CO TAX NAP DIST"AO SECTION 55 BLOCK�_LO1 15.5 HEREON,AND TO THE ASSIGNEES OF THE LENDING I` Y. RTM(P[ Alit NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITUTION GUARANTEES ARE NOT TRANSFERABLE '•� OTHER THAN THOSE SHOWN HEREON TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT �.�� C:......' Q ■TN[WATER SUPPLY Alp 3EW/B[DISPOSAL SYSTDI FOR TINS RESIDENCE *DISTANCES SHOWN HEREON FROM PROPERTY UNEP tT�•58cs ,#O WILL CONFORM TO THE STANDARD!Of THE SUPFOIR COUNTY TO DISTING STRUCTURES ARE FOR A SPECIFIC LANpS 0/HEAL TM MINIM I . PURPOSE AMD ARE NOT TO SE uSED TO ES TALLISH APPLICANT. ` PROPERTY LINES OR FOR THE ERECTION OF FENCES ADDRESS _ TEL YOUNG & YOUNG �°OSTRANDER AVENUE W NOTE, Q-STAKE ■=MONUMENT ALDEN W.YOUNG,PROFESSIONAL ENGINEER SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON MARCH 19, 1990 AS FILE NO. 8912 AND LAND SURVEYOR N Y.S.LICENSE NO 12845 • HOWARD W.YOUNG, LAND SURVEYOR * NTH(Laura aP WS.LIW1,stme TANNtITTD cts1POoLst01 OHOWN'sofas N.Y.S.LICENSE NO.45893 • Mt PROM P151RIMRI 8 OTIONS D OR DATA OBTAINEFDO D *OTHERS . . 'RAMS•SONS INC. , •