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ELIZABETH A. NEVILLE �� � �, ; Town Hall, 53095 Main Road
TOWN CLERK _ ,n0" P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
r",,r",,f Pra Southold, New York 11971
® kms ` �1 Fax (631) 765-6145
MARRIAGE OFFICER `4r4r, „ ®�'t
RECORDS MANAGEMENT OFFICER _ ®� 1),* iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �
e--s..",
OFFICE OF THE TOWN CLERK
SOUTHOLD '1003117EMAgEIRTEEDIRDSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2606 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : NORTH FORK MANAGEMENT
Address 1 : PO BOX 696
City St Zip AQUEBOGUE NY 11931
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 #R10-01-0115
Name Of Owner PECONIC DESIGN & CONSTRUCTION
Mailing Address 1 PO BOX 1143
City St Zip CUTCHOGUE NY 11935
Property Address 1 PARADISE SHORE ROAD
City St Zip SOUTHOLD NY 11971 •
Tax Map No. section 80.00 block 1 lot 13.000
Cross Street NORTH BAYVIEW ROAD
Building Permit Number Cross Reference:
Issue Date: 6/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
60 .
. 0,j-
ELIZABETH A. NEVILLE ,' . -` �0 Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
§ V Southold, New York 11971
MARRIAGE OFFICER ���1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICERV®�/ .ss�42,,, �•�1° Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `Ls /
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 20, 2001
Transmitted herewith is a copy of application No. 2695 for a Cesspool/Septic Tank Construction
Permit submitted by:
North Fork Management
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:
Signa
a (
Dated
s :4.
OFFICE OF THE TOWN CLERK Os' O •
f WA -- q
TOWN OF SOUTHOLD ��" \ Q� Application No.�� CLS
ELIZABETH A.NEVILLE,TOWN CLERK i 0
P.O.BOX 1179 Construction ✓
SOUTHOLD,NEW YORK 11971 vm
. � �1 Alteration
Telephone *0 �4 •rt: $10.00 - Residential
(631) 765-1800 _ 1 ��,r' $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT R IE C E l V g D
SEPTIC TANK or CESSPOOL
JUN. 2020
Permit No. 2.arreogo. lawn, Clerk
Fee .$
DATE oda/
• APPLICANT NAME: /0°/e/#Ata' /14(60-/G1///,,r./74-
APPLICANT
14(60-/Gf/1yf,r./YAPPLICANT ADDRESS: / ,&,4( 67I
142 / ,37u6_ ,7//73/ -
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/Vein ,ug./f Apt, ' /ecsi ,,6/'
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: //
• OWNER OF PROPERTY: /low/ /�fsg y 9- ,,vs�eur�i'adil
OWNER MAILING ADDRESS: . ,&o-( //ff.�
&14',V e ,,r/./ //f3S—
OWNER PROPERTY ADDRESS: te)9,0/5J $� 4 r "p/
TELEPHONE NUMBER OF CONTACT PERSON: 71.2 -,r?%0 - 57‘ /ecEL-
TAX MAP NO. : Section 'O Block f Lot / 3
CROSS STREET: /3inrisf 5#01i 4 51 A. / y11/fes/
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signat of Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
SURVEY OF PROPERTY - - , - ,t
SITUATE: BA 1 V IEI 1 exIsting
N �� V �
well
TOWN: SOUTHOLI7 E
SUFFOLK COUNTY, NY w
SURVEYED 03-15-01, AMENDED 05-03-01 S
SUFFOLK COUNTY TAX #
1000-80-1-13
CERTIFIED TO:
PECONIG DESIGN 8 CONSTRUCTION CORP.
oll
COMMONWEALTH TITLE INSURANCE COMPANY
O exlsting
septic
LN:IqY
Test Hole existing DL\FLLLNG z0
03-25-01 welles PLSLAND A�o AKSTMRL� OFz zAs
O J JLBROM OAMY SUFFOLK COUNT DEPART MENI O: F, .z TH SERVICES e4� S69°48, Il -�e% "g 3N
SILT Q40E
� well Q U2• PERMIT FO=a APPRO,2.3.,C- ': NSTRUCTION FOR A 0,-..v fa *esr 150 62' 1La,
6 ? �T��,s yy}'�+iy p,H k^, f" - x.s7i3;{A'S' septic Iet.e I
13�d�t lG�pJ'E Jl.t]]�G...-.. El.� °S 1_r_J ONLY� O
system O 1-- \°J6 el�.
DA TR a
c)‘ Ara
_,., I'RO SERVIGE�R ' ' w w,0
APPROVED0 W O Z — _ �`
�w U:) 0
,,
PALE
FOR MAXIMUM OF L BEDROOMS TO 3 00 kL i N z li
M EXPIRES THREE YEARS FROM DATE OF APPROVAL ® 3 q om- N
SAND l r J9EPTIG'� yTEM 30__-- -- '', O ry existing
0 P
�) eco O ' , o 1aJ
L O
N69 48,40„4 0
existing -7Z O . (N �
0 septic V O ; 149.20, • exlsting
well
!Y LAND NON .t s,• LL
R
17. i JOL IN B BU RLY OF ` — — --rim o (I)
n , — - (--
.01_ m ' LL 7=' f'i7
O i VACANT F 2 D= —4 •— ru
,�o J Dwelling �rn S 1 CD
a- 1L W exlsting with ---17 ,.o „_-ti ru
L1 , septic Publle R1{—
NOTE: SEPTIC. OF LESS THAN 150' REQUIRES 40' OF p O lbte �---1' —.
WATER IN WELL OR A VARIANCE FROM THE S.G.D.H.S. i Service �� -21 ;_j m
, rnrn =C7
LOCATIONS OF ADJOINING WELLS AND SEPTIC SYSTEMS �R: �••�+ ..J
•
SHOWN HERE ON WERE OBTAINED FROM FIELD OBSERVATIONS, ri. �X S.,� w -<
PAROLE EVIDENCE AND ADJOINING SURVEY LOCATIONS BY OTHERS. �e/i, �O� f\J . {� �� Lo
/fQ'���G. Eyl d '
t,Tla. w' rs. . mea•
• 3 i °"am",,.7..�. �".:..
NOTES: existing tii
e welig ;<e --L�% ''':";c:"'"----4 p -CartSKa�o„ a ,J,,tt e,
• MONUMENT e g v419 0. 502��p ( ,i 1':,� ;, :V=
well
w.hirsa.e. -u.....-.7....,Z
• PIPE OR PIN •• vu, ,wume
• SAND 5 V��°'.11:3".I.7".......��.
AREA = 11,244 SF OR 0.26 ACRES JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S.LIC.NO.50202
GRAPHIC SCALE 1"- 40' RIVERHEAD,N.Y.11901
1== 369-8288 Fax 369-8287 \�P server\d\PROS\01-131.pro