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ELIZABETH A. NEVILLE '= yd; Town Hall, 53095 Main Road
TOWN CLERK o • P.O. Box 1179
ci)REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
MARRIAGE OFFICER ` ,fi s:. Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER =__-'/QlAKE %t oiii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2837 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DONALD FEILER
Address 1 : PO BOX 1692
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-01-0223
Name Of Owner BLESSINGER, WILLIAM
Mailing Address 1 845 HEMPSTEAD TURNPIKE
City St Zip FRANKLIN SQUARE NY 0000
Property Address 1 WESTPHALIA RD
City St Zip MATTITUCK NY 11952
Tax Map No. section 114.00 block 7 lot 10.008
Cross Street NORTH ROAD
Building Permit Number Cross Reference:
Issue Date: 7/23/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
•
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oe
ELIZABETH A. NEVILLE Town Hall, 53095 Main Road
TOWN CLERKto - P.O. Box 1179
ft
�y, Southold, New York 11971
REGISTRAR.OF VITAL STATISTICS
MARRIAGE OFFICER Fax (631) 765-6145
:� ?i �1
RECORDS MANAGEMENT OFFICER '*o, ,,, °i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ ,s" southoldtown.northfork.net
... .tail
OFFICE OF THE TOWN CLERK
JUN 2 0 2UO2 TOWN OF SOUTHOLD
TO . ' Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 20, 2002
Transmitted herewith is a copy of application No. 2940 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Donald Feller for Lawrence Blessinger
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.
Linda J. Cooper
* * * *
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED.
-49(414074, /Ke. tee 40,
rAtfv44‘‘/I-7,
Signature
/.3-0/2._..
Dated
OFFICE OF THE TOWN CLERK '
TOWN OF SOUTHOLD ,,` c��Ffr�CKcpli Application No.c;.? va
ELIZABETH A.NEVILLE,TOWN CLERK O
P.O.BOX 1179 < Construction
SOUTHOLD,NEW YORK 11971 =v rn
4 Alteration
Telephone it $10.00 - Residential
(516) 765-1801 -- .� ��'�
' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE 2-0 /O
APPLICANT NAME: A't/10 r151 LeV"L
APPLICANT ADDRESS: I r`Ps t Q-.0 P19 0 d 4 )(p v
ISA--rr -ia
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
n1 Dw L- (j 5 clam Se4T
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:¢,?2
OWNER OF PROPERTY: UPI/kJ PlEOCS —t . NQ
OWNER MAILING ADDRESS: 69-5 }i-te rtiQS 15P IPI.
SCIo OAS N
OWNER PROPERTY ADDRESS: KPE514:ttri lel P, P---o(610
fTTVIL)C44___
TELEPHONE NUMBER OF CONTACT PERSON: 2-1 j - 51-543
TAX MAP NO. : Section 1 \' Block 0 "7 Lot I � ' $
CROSS STREET: TA0(-' "1-IR-OPV
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
' 'I •
Signature of Applicant
RECEIVED BY: p�
Town CI rk's Office
DATE: to— 020- C>d�
TEST HOLE DATA
SURVEY OF PROPERTY (TEST HOLE'BUG BY ON JULY 20, 2001) N 0 J jj :, i N
SITUATED AT 1°
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aw
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SUFFOLK COUNTY, NEW YORK ME MOAN ow TO MORIN WE is oEpi
S.C. TAX No. 1000-114-07-10.8
SCALE 1"=50' L
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N.Y.S. Lic. No. 49668
• .2�, 4. UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOUTION OF
SECTION 7209 OF THE NEW YORK STATE
EDUCATION . Joseph A. ingegno
r'"P ..',;� Cv -- ;l 1 _ �a M" TIE LAND SURVEYOR'S INKED SEAL OR
lJ / N COPIES OF THIS SURVEY IMP NDT BEARING
R = 5 �,.'
TO ANNA T Com,. Land Surveyor
.IP
*MATED HEREON NULL RUN
.:� .'��.• =tet. ,...,:.,.,.,� IS Pte. AND ON HS BEHALF TO THE
V .1 yY TITLE COMPANY, GOVERNMENTAL AGENCY AND TIL a Surveys - Subdivisions — Site Plans — Construction Layout *1'
1i .s �,. n: c 2:::-.;•_G viai'.9� LENDING NSTlTi1TION LISTED HEREON,ANO
THE ASSONEESTTmON. CERTIFICATIONS ARE
LENDING INSTI-
TTRANSFERABLE. PHONE (631)727-2090 Fox (631)727-1727
°-•�-,�-a•�,_ _ -.,. _
THE EXISTENCE OF RIGHT OF WAYS
AND/OR EASEMENTS OF RECORD. IF OFFICES LOCATED AT MAILING ADDRESS
ANY. NOT SHOWN ARE NOT GUARANTEED. 1380 ROANOI(E AVENUE P.O. Box 1931
RNERHEAO, Nor York 11901 Riverhead, Nen York 11901-0965
21-40;