HomeMy WebLinkAboutGrim, Donald B ` Town Hall, 53095 Main Road
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%0 �� P.O. Box 1179
'��ID a. � Southold, New York 11971
JUDITH T.TERRY �ii•0° TELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 385 R Residential X Non-Residential
Fee $ 10.00 Septic Cesspool X
PERMIT ISSUED TO:
Name : GRIM, DONALD
Address 1: 475 JERNICK LANE
City St Zip SOUTHOLD NY 11971
Descripton of Proposed Construction or Alteration
NEW SINGLE FAMILY DWELLING WITH CESSPOOL SYSTEM.
APROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY HEALTH
DEPARTMENT 5/10/88.
Name Of Owner GRIM, DONALD
Mailing Address 1 475 JERNICK LANE
City St Zip SOUTHOLD NY 11971
Property Address 1 DENKEL LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 97.00 block 10 lot 23 .002
Cross Street MAIN ROAD
Building Permit Number Cross Reference:
Issue Date: 8/22/88 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
E 1►► E \-j f$
fel 1 X5198804.
BLDG. OL'T' �' Town Hall, 53095 Main Road
TOWN OF SOUTHOLD `y (,�;
"' P.O. Box 1179
`off u �� ��� Southold, New York 11971
JUDITH T.TERRY '�
—"P•erooii iTELEPHONE
TOWN CLERK (516) 765-1801
REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
To: Victor Lessard, Southold Town Building Department
From: Linda Cooper, Southold Town Clerk's Office
Dated: August 15, 1988
Transmitted herewith is a copy of application No. 391 for a Cesspool/
Septic Tank Construction Permit submitted by:
Don Grim
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 X
DISAPPROVE nn'' nn sits_
�
Comments: 4.,e, d[ cq- rX- C - a
ofvv.ti S2441 ry, 400) Rs
Signature
Dated
III
OFFICE OF THE TOWN CLERKcS"FOC,�'4,�
Town of Southold i.. oGi�a Application No. _3 y /
Judith T. Terry, Town Clerk ' 7�
Town Hall, 53095 Main Road �. Construction
P. O. Box 1179c Alteration
Southold, New York 11971 �i
Tele hone "Ol � Residential
p
(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 $ /10 —
DATE /b —'d.'
(7---
APPLICANT NAME: 7J?2N (4/2//xj
APPLICANT ADDRESS: / J /.2//ft' �'� Ii-
SEPTIC
CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
NE 14/ Not L c AE:
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRU TION OR ALTERATION:
OWNER OF PROPERTY: C! /i g/zlf i
OWNER MAILING ADDRESS: /" /ZA'i /( L.,-
, 0e) /4
OWNER PROPERTY ADDRESS: 2I7bA'DblV ,4
.../C1 /If,-
TELEPHONE NUMBER OF CONTACT PERSON: WitSc),?
TAX MAP NO. : Section 9'2' Block C / Lot (, c 2 cR
CROSS STREET: 744 / 1 RID
BUILDING PERMIT NUMBER CROSS REFERENCE:
I ..LAS /
1..r
Signature ofApplicant
RECEIVED BY. X c _-��!% -2 C-C
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DATE: / p4`%
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THE LOCATION OF WELLS AND CESSPOOLS SHOWN HEREON ARE FROM FIELD 6'j, C. . vv
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SURVEY FOR h •�A>. - •
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DONALD GRIM & JE'A NNE GRACE' �y1
AT CUTCHOGUE p,
TOWN OF SOUTHOLD 0, X ,,,o Q
SUFFOLK COUNTY, N.Y. O+. �•ij '�oDINe) ) 1 ,�
097 01 P/O-_ `23:2 S b.
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SCALE, 1" =40'
(......7 V SUFFOLK Cc' itMY (74Vs fS2 et € € imAii fr'.
NOV. 3, 198 7FCR A T20 AL et ;ta ,si 1 :y
X17 S ,J-e.-i ui c(C Aa _ DATE ) U
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The water supply & sewage disposal sys- R-
IC- //q7/ s . �,: °0 — (�
/ terns for this residence will conform to the -1:4111.410,`
_+�
y q standards of the Suffolk County Depart- APPROVED I
tw► s. l / I
�-g VC, ern e
�--'f� � ment •. Health 5
.27q �ICk �ri re- ,
lCQ :LS III , JJ y 0736 AREA = 44,248 SQ. FT.
/ � Prepare: in accordance with the mu
t 5f! b! for title surveys as estaU{i_h_. w• t ,, rt'it;:-!-t t r• R ; ,
J 4 0 �b standards y -. t ; 'r t,
70S— / 4,s—.0-- the L.I.A.L S. and approved and ad„r tem.i.lr.t!1-i r�',J y L ,• DI-,
-. -• k, t
LANDS for such use by The New York State Land' CER:TIFIED)7761 -1,~r1� t i (-1 i-- j'A ► ,h1.�jil {' f
�� (/ Title Association. OMNI ABSTRACT CORP. `i;, 0” '
�� �1. MET 9` CHICAGO TITLE INSURANCE COMPANY''
ti V/ .
.� �c� c�,� DONALD GRIM • APR 29 1 c
��j '�= � ��..7• ', . NO. 49618 JEANNE GRACE
OECONl� �l R71.77:'
�;' & NiiNEERS, P.C. LOT NUMBERS ARE REFERENCED TO MINOR SUBDIVISION M ,F_C�Q
(516) 7.'. 50 • '�' WILLIAM L. 8 MURIEL A. MURRAY FILED IN THE OFFICE F e--5pU�HOt
P.O. BO ; • ft 40618 AT •rntint ri rPle �'t.'• 1t I 4, n','it`i e 1