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JUDITH T. TERRY Z : Town Hall, 53095 Main Road
TOWN CLERK T P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS il'S Southold, New York 11971
MARRIAGE OFFICER _ y0s sr Fax (516) 765-1823
vArn 1D Fax
(516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 1009 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : RIVERSIDE HOMES, INC.
Address 1 : P. O. BOX 274
City St Zip RIVERHEAD NY 11901
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES.
Name Of Owner GORDON, FREDDA
Mailing Address 1 404 CROWN STREET
City St Zip BROOKLYN NY 11225
Property Address 1 SUMMER LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 78.00 block 9 lot 10.000
Cross Street SUMMIT ROAD
Building Permit Number Cross Reference:
Issue Date: 6/08/93 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
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JUDITH T. TERRY � y= Town Hall, 53095 Main Road
TOWN CLERK , O rT P.O. Box 1 179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER lob
� �t, Fax (516) 765-1823
1 $7,0' Telephone (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: June 2, 1993
Transmitted herewith is a copy of application No. 1038 for a Cesspool/
Septic Tank Construction Permit submitted by:
Riverside Homes, Inc. for Fredda Gordon
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 reco mendations:
APPROVE
DISAPPROVE
Comments: 41-0..
A;1,11.L4--
76,-%- ----
Signature
OFFICE OF THE TOWN CLERK
Town of Southold Application No. AO 3 I(
Judith T. Terry, Town Clerk ,/
Town Hall, 53095 Main Road Construction
P. O. Box 1179 Alteration
Southold, New York 11971
Residential
Telephone
(516) 765-1801 Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
I APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE
•
APPLICANT NAME: RIVERSIDE HOMES, INC.
APPLICANT ADDRESS: PO Box 274, Riverhead, New York 11901
Y
SEPTIC CESSPOOL�x
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
Construction of single family dwelling
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY : Fredda Gordon
OWNER MAILING ADDRESS: 404 Crown Street, Brooklyn, New York _11.e3a.y
..- ._. -- Lot_No. ..16.
OWNER PROPERTY ADDRESS: �- Summer La 100; N/O-Summit Rd.
May of Bayside Terrace, map No. 2034
TELEPHONE NUMBER OF CONTACT PERSON: 727-3395 Richard. Wandoloski
TAX MAP NO. : Section 78 Block 9 Lot 10
CROSS STREET : swim;I- Rnarl
BUILDING PERMIT NUMBER CROSS REFERENCE: -', I
RIVERSIDE Hi ,ES,
ElI 0
Sig . ure of Applicant
RECEIVED BY : . W
Town Clerk's Office
DATE: 60 7-L-/
` The local/ons of webs and cesspools
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, 6' / and or from do/a obtained from others.
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o'
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_ . 14.5' SU
,fie V Aga l/r AREA = 12 , 000 SQ .FT.
drown IQ
OR 0. 27 ACRE
Coarse' O
S i7d.S 21 p
SURVEY OF
LOT 16
CERTIFIED TO. MAP OF BAYSIDE TERRACE II
ANTHONY FAVITTA FILED MARCH 11 , 1953 FILE NO. 2034
USDA FARMERS HOME ADAI/NISTRA TION
Theandre" AT BAYVIEW
slaws ler #is redefine* wit m TOWN OF SOUTHOLD
to Al. slew** eel lb Set Coolly
Overload o1 Him* Services, SUFFOLK COUNTY , N . Y.
1 --,.. ,K.x
=' `-F •, 1000 - 078 - 09 - I0
-- _ SCALE 1" . 3 0
1. -' = SEPT. 2 , 1987
3
Cj 'o0 T.Me%44. ipfr FORONLY
c......) + SUFFOLK CCO1. TY DEPART
OF TMMENT OF HE Th SERVICES
f �4 ... *
/ r�. i DATE HS. REF. NO.
A1'A' ��•1,.' - N. LIC. NO. 496/8
"ECO :Aki ;'- *7 P.C.
f5/61 7• '1.• '• APPROVED
P. 0. BOX " • ' ELEVATIONS ARE REFERENCED
MAIN ROAD TO AN ASSUMED DATUM
SOUTHOLD, N.Y. 1197/ Flee.
87 - 744