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ELIZABETH A. NEVILLE ��� � 4z Town Hall, 53095 Main Road
7.4
TOWN CLERK % ® �x ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ` .- '" °� Southold, New York 11971
MARRIAGE OFFICER :. w ®�/�1 Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER = 1.1 EZ3 $ i Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER - D'
OFFICE OF THE TOWN CLERK
SOUTHOLDi'NE ITECU1DSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2601 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROBERT KENNEY
Address 1 : PO BOX 303
City St Zip CUTCHOGUE NY 11935
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 #R10-01-0098
Name Of Owner KENNEY, ROBERT & LINDA
Mailing Address 1 PO BOX 303
City St Zip CUTCHOGUE NY 11935
Property Address 1 90 COUNTRY CLUB DRIVE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 109.00 block 3 lot 2.006
Cross Street MOORES LANE
Building Permit Number Cross Reference:
Issue Date: 6/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
ofFour
oe, 66
ELIZABETH A.NEVILLE • Town Hall, 53095 Main Road
TOWN CLERK ti • 2 P.O. Box 1179
REGISTRAR OF VITAL STATISTICS V' �� Southold, New York 11971
MARRIAGE OFFICER :®� ���1� Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER L �Q� ��®��� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ��
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: June 4, 2001
Transmitted herewith is a copy of application No. 2689 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Robert Kenney
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.
Signature
6/tfi„
Dated
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OFFICE OF THE TOWN CLERK �'.'` �F�U�K
TOWN OF SOUTHOLD ,� � CSG Application No.a �f
G�
RT.T7ABETH A.NEWJ•F,TOWN CLERK
P.O.BOX 1179 • Construction
SOUTHOLD,NEW YORK 11971 o T
• • Alteration
Telephone , p� tee'
$10.00 -Residential
(631) 765-1800 � $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
•
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 6 e
APPLICANT NAME: /4t. 47-
APPLICANT
t. 47-APPLICANT ADDRESS: 2) box' 7 6 I A) .1/:
/
SEPTIC t/ CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
OW6—,4-fitl` 1
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: /2-D Z c— � 4- / 41A/
OWNER MAILING ADDRESS: Po 60C ja 3
�u
rchtolur iou l 119 C
OWNER PROPERTY ADDRESS: 7,o C U N'r 16-
etas
� r- *DI l9 � y
TELEPHONE NUMBER OF CONTACT PERSON: C. ) ç19 a7
l®
TAX MAP NO. : Section l Block %.3 Lot V.
CROSS STREET: RO ci .s
BUILDING PERMIT NUMBER CROSS REFERENCE:
Ze-tY1
Signature o Applicant
RECEIVED BY:
T� wn Clerk's Office
DATE: Col Q(
-,. _ fDLOT
SURVEY OF PROPERTY
vELLS & c•ps 150'+ AT CUTCHOGUE
"- - S 84.34'10' E 63'W TOWN OF SOUTHOLD
' - ` EL 30.7• r78,00, FETOWN
I SUFFOLK COUNTY, NEW "3,'ORK
-' 1000-T1�09-03-2.6
- EL 304'I £L 309' SCALE: 1'=40'
CtS ti I
APRIL 17, 2001
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N PERMIT FOR APPROVAL OF CONSTRUCTION FOR A
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coCgL�IT 144
SINGLE FAM[L1C RE5IDENCE ONLY
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IV 79 5S,-- P` 6'me�f , <>cZ5 ri
APPROVED ��� i
le, 1111 r! OO o `C�EnR00iAS
—`�o. FoR MAXIMUM OF
EL 2�2' r69" EL 293 ti 1 EXPIRES THREE YEAR`I FROM Dili L O`r f.PPROVAL
ti
14 3
-ciii:150' -(Ak 411.7 G.) - �...,1 m� -0 -T'LaJ -
EGL coc 3 u, N r C'
I - NKNCII,,N �..OF N fW y �'
r' faThilar VLrt�j the, ST1DAiIi F[f�i fiPPR� aL''_
-teiNSTRUCT Eild,FC1F:gki.i �URf p': W,,A,�aE - ': = ; -
RflSA{r.SYSTEMF11R �i11Gi 1~' ft6�F4 t11� SSC n3ENG�t-•; ��P�N\ MFTj° ?,� ..
t 4 #: txill abide•b•�% the -tarn(;S�n'l ',sem-`Perth therein, and '° F4 c' z
the perrtitt ta':eeiasti^;ui~'i=?;•. - 'F el, * '_;`.
.i - . til IV
v > location'of•wets and o ssppcs{S ,,s-Town .hereon, are i:.''� �",. LIC NO. 49618
f Nm field `dfaset^.vtitions"gncl;_tnc�.c t.t.d 'obtained- tram others, • "'l V��r•
i , :i
PE N',r:� i%i: 1` S, P.C.
vations are referenced to ans o surfed,datum, my ALTERATION OR ADDITION'TO THIS SURVEY IS A vIOBATION LOT NUMBERS REFER TO 'COUNTRY CLUB (631) ,4ANo 1 FAX(631) 765-1797
i:• , + tr SECT/ON 7209 OF THE NEW YORK STATE EDUCATION LAV,
• Y-- ' `"1. ' -p . EXCEP,T AS EC
PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS ESTATES' FILED IN THE SUFFOLK COUNTY P. D. BD - ,
=MCIIJUMENT - ' _ HEREON P O VALID FOR THIS MAP AND COPIES THEREOF ONLY IF1230 TRAVELER STREET
cPTIJI- L'?11.S,EES.�' :.,L '`v1.3"t SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR LERK�$ OFFICE ON OCT. 17, 1978 AS FILE 0
CFI!lrurN n m v 11071 n _ I li