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• ELIZABETH A. NEVILLE �� At° e.: Town Hall, 53095 Main Road TOWN CLERK ; P.O. Box 1179 REGISTRAR OF VITAL STATISTICS +�� Southold, New York 11971 MARRIAGE OFFICER 11 Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER =_�®� ®1i1� Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER � OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 2512 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : TOM & TRACY NOLAN Address 1 : 41 DOUGG LANE City St Zip SOUTH JAMESPORT NY 11970 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 #R10-99-0234 Name Of Owner NELSON, TOM Mailing Address 1 41 DOUGG LANE City St Zip SOUTH JAMESPORT NY 11970 Property Address 1 COUNTRY CLUB DRIVE City St Zip CUTCHOGUE NY 11935 Tax Map No. section 109.00 block 3 lot 2.007 Cross Street LINDEN AVENUE Building Permit Number Cross Reference: Issue Date: 2/21/01 Elizabeth A. Neville Southold Town Clerk (TOWN SEAL) i//iii ��,��oS11FF0��-c; QS, ,' ® OG ELIZABETH A. NEVILLE 1t1 j ?'�: Town Hall, 53095 Main Road TOWN CLERK ; y 2 P.O. Box 1179 REGISTRAR OF VITAL STATISTICS ` Southold, New York 11971 MARRIAGE OFFICER �� . ``�11+� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER x__701 .��®�1i1 Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER 0'� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: February 13, 2001 Transmitted herewith is a copy of application No. 2600 for a Cesspool/Septic Tank Construction Permit submitted by: Tom& Tracy Nolan 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: , . /Signature �- 11'161 Dated ti t±.41r OFFICE OF THE TOWN CLERK � � �Ff OCK � TOWN OF SOUTHOLD � � Q�/ Application No.O� FT T7ABETH A.NEWT LF,TOWN CLERK �'C41 i44\ P.O. P.O.BOX 1179 Construction SOUTHOLD,NEW YORK 11971 0 __ I tt1 Alteration Telephone �,y �Q �' $10.00 - Residential gL— (631) 765-1800 =- 1 ,�� $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 APPLICANT NAME: To_v14. c /!Q 0 APPLICANT ADDRESS: r at•���===�J���_ = <<, qi iDavc05. Lvt-- S . - SEPTIC ✓ CESSPOOL V DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION /‘-' e LOCATION MAP: Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY: t6 l� OWNER MAILING ADDRESS: (// Qou,, 4-C) VV OWNER PROPERTY A_ DD_RESS: V 1 YN- C LADI � i� Cin sem _ TELEPHONE NUMBER OF CONTACT PERSON: Q I;� 736/-6917 TAX MAP NO. : pction / iik;Tock 3 Lot rw� r � CROSS STREE ► ALA_ a It i J AA_( r 9 BUILDING PERMIT NUMBER CROSS REFERENCE: • Si natre of licant �,� J P RECEIVED BY: �. mw` T•wn Cle k's Office DATE: & �� ° ' f .; _ , ! N SURVEY OF h 2Q E ^10 'j L O T 28 ', . 5Q, i E.3 , _ __ _ IN `�� 12 a • _ MAP OF COUNTRY CLUB ESTATES N 1•�1' S ` „iib„ OT.,.32 a.._,.__.?_-__a SITUATE 2 CM �1CU TCHOGUE, C /0 ,, _ . - TOWN OF SOUTHOLD e > ,SUFFOLK COUNTY, N. Y. N 15��0, - SURVEYED FOR DAVID McELROY NORTH BAY PROPERTIES, INC. I\ N cm , rn - OS ` ' ' , PROPOSED ® CN WELL I ' LOT 27 / , I VACANT S7>< I SET n cf) I LOT .: ' • l STK , VACANT ' -` / SET _ ) »+-' "'11 I _ © Q O I/ T Y i' d C1.4. , 4 BEDROOM ,.77:en, C7-0 sEr TEST Ncnq `;. �, -4 HOLE , 5..- SET 1-11 ) illPROPOSED j_ j O SEPTIC TANK PROP.� T ASPH. � - NI- 1 DW 0 PROPOSED I1 0 CESSPOOL 0 S O co 0 W — �n , o Ill - CM s�-sera• : — A.. 41.30' / ) O gli N 79' 55' 10” W 161.40' TIE= 169.27' AFP nd • COUNTRY CLUB DRIVE , , WITHIN14/ELLS 4/ L S O R OF 5 CESOOLS SITE. • ZONE R40 • TEST HOLE DATA TM 1000-109-03-02.7 FM # 6736 FOR S.C.D.H.S. USE ONLY TEST HOLE #4 AS SHOWN ON FILE MAP FILED: OCT. 17, 1978 r— EXIS77NG GRADE SURVEYED 27 OCTOBER,* 1999 'J\�, ; ‘,K•\\i\�% `• TOP SOIL • SCALE 1'=40' — —0.5' AREA= 41,297SF OR LOAM 0.948 ACRES • ------ ---•-- Guarantees indicated here on shall nm, ,.� 'os only to the person for whom the survey iii ,4- —T0' p , ,^, tri ��; — is prepared, and on his behalf to the t * title company, Govermentai Agency, '' lending institution, if listed hereon, and col kl �' '+$ r'S to the assignees of the lending institution. ;�4 C:� e. . w r: t ? Guarantees are transfsi'4bla to d ' "-" 'as � SAND AND GRAVEL additional insiitetio not Cr s,b9equent oraner i � � �w tw r 1,1.0E.; r4 h1 r1GUARANTEED TO Yui a --C3 "i DAVID McELROY ti ' '' ,,,a ti �„ �' NORTH BAY PROPERTIES, INC. O •I; M ,Si. gi t"6 14' COVENANT ABSTRACT CO. INC. TOWN OF SOUTHOLD tl1 i ^TM :ap tri -j" ' . p" Unauthorized alteration or addition to this ti a t ra ,` survey is a violation of Section 7209 of SURVEYED BY f . \ , CSI' , the NOW York State Education Law, • STANCE)' J. ISAKSEN JR. P.J. BOX 294 ' � ,.T; P„' NEW SUFFOLK NY 11956 n �-wg s` 57r� - 34-58,35 1 Cctpi s Of this Survey Map not beat' „I�`rNS, AND S •J'�EYOfh 11te Lord Surveyors eittbossed seal shall l mnfYy G G. 49/ .3 het be cer,sidered to be a vtltd trot ^ 99C-83-'7, ,