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ELIZABETH A.NEVILLE �►� + 4>_ 0. Town Hall, 53095 Main Road
TOWN CLERK ; g 1 `=;n' P.O. Box 1179
tp,REGISTRAR OF VITAL STATISTICS "� 't s'' Southold, New York 11971
MARRIAGE OFFICER ® , Fax(631) 765-6145
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RECORDS MANAGEMENT OFFICER % ,�.r22,, ��� t1� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `z s' �S"
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2540 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DONALD R. CONNOLLY
Address 1 : 22 CENTER GARDEN BLVD
City St Zip YAPANK NY 11980
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. REF10-01-0045
Name Of Owner CONNOLLY, DONALD R.
Mailing Address 1 22 CENTER GARDEN BLVD
City St Zip YAPANK NY 11980
Property Address 1 WATER TERRACE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 88.00 block 6 lot 13.005
Cross Street MAIN BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 4/16/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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a5 Lito
ELIZABETH A. NEVILLE �e 0 Town Hall, 53095 Main Road
TOWN CLERK ® - `" ` � `
'�, ; �� �; � � P.O. Box 1179
REGISTRAR OF VITAL STATISTICSt 1, Southold, New York 11971
MARRIAGE OFFICER . , 1 Fax(631) 765-6145
RECORDS MANAGEMENT.OFFICER _® z ����1 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ o'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 22, 2001
Transmitted herewith is a copy of application No. 2628 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Donald R. Connolly
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.
Signa
lib
Dated
1 1,77 .
1
OFFICE OF THE TOWN CLERK 011COLk '
TOW �;
N OF , 0�� COG ; Application No. 26,za
FT i7ABETH A.NEVILLE,TOWN CLERK � ' • 'y
P.O.BOX 1179 % Construction
SOUTHOLD,NEW YORK 11971 : o rn ; Alteration
Telephone , O,y ; 4.•
/ $10.00 - Residential t"‹..(631) 765-1800 ---__70.1, ��'• $25.00 - Non-Residential
•
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
•
Permit No.
Fee .$
DATE rj -- e -D--- ° 0
APPLICANT NAME: ,l Off A-L b 1>, CO,n4 Am L CAr
APPLICANT ADDRESS: , (F 7-�/e. t ,,,,Fd NE/J G lid
ti A pinA-h1 k ovy. / 1 0
SEPTIC X CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION 9
OR ALTERATION
S 'sf- 6 (L DJ &v,) COAf.c 4ezMC-4-foi.1
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
OWNER OF PROPERTY: 3OI.J,q.LD 17 , CD/Jmfo .Ly 4 Su So,A) •
OWNER MAILING ADDRESS: r2 A Ce Nfev, Cc4ez.dig iJ E I lS T-
',7 pie,,i k `J(-j . //9t-O I r
OWNER PROPERTY ADDRESS: /p 1-- 3 '-w �i•e I SJ CR, 5
Sot_44L b Id /0,(/, r l '/7 /
TELEPHONE NUMBER OF CONTACT PERSON: (b31) . `-13---- 4 Z z.3 16fri•
5'16 -- 6 3 �0 — � 2-Z
TAX MAP NO. : Section O4' Block C. la Lot 13 , S—
CROSS
3 , cCROSS STREET: V-A 1 dJ 3 Al 0 1t - w
BUILDING PERMIT NUMBER CROSS REERENCE:
,,(d e, 6‘ , . b .
Signature of Applicant
RECEIVED BY: CC ---S) •�
Town lerk's Office
DATE: yi---2.--- 0 i
SURVEY OF /
TM 1000-088-06-13.5 LOT# 111t.
3 Y'
SURVEYED 8 MAY, 2000
FM ' 9729 MAP OF ANGEL SHORES SCALE 1"=30'
FILED AUG. 23, 1995 SITUATE
AREA= 30,000 SF
BA YVIEW, OR •
TOWN. OF SOU THOLD . 0.6887 ACRES
GUARANTEED TO SUFFOLK COUNTY, N. Y.
DONALD R. CONNOLLY ZONED AC
SUSAN T. ,CONNOLL Y SURVEYED FOR DONALD R. CONNOLL Y
SUFFOLK COUNTY NATIONAL BANK NOTE. ELEVATIONS SHOWN HEREON
STEWART TITLE INS. CO. SUSAN T. CONNOLL Y ALL ARE UTILITIES ASSUMEDEDATUM
GROUND
# NMS — 00 — 6134
ALL LAND VACANT WITHIN 150' OF THIS LOT
PARCEL 'B' ALL UTILITIES BELOW GROUND
S 58' 01' 20" E 150'
fD AFv
CM STAKE
O
QI N
O
N
3 LOT GEN'L- ' LEVEL WITH
In PITCH TO THE EAST
a
r
W
C1
U
W
4.. \,.....---"----2
2 2
f 1Z' I
¢•( LOT 4
1. 18' i.
LOT 2 1to
12'
1d' PROPOSED
4 BEDROOM
RES.
N GARAGE
�1 20' .
W24'..5..33'
It 3B' 1 '
W PROPOSED I •
SEPTIC 1_1-17 -
O O j•
TANK U
I
1., 0 0 I ce o
PROPOSED-----\,
L `i
jCESSPOOL o ``%
VI
Q ZELECTRIC,
I-VAULT FO
STAKE
• TIE= 305' cm N 58' 01' 20" W 150'
BELGIUM BLOCK CURB
•
VVA TER TERRACE , GUARANTEES INDICATED HERE ON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
WM ASPHALT PAV'T IS PREPARED, AND ON HIS BEHALF TO THE
WM TITLE COMPANY, GOVERNMENTAL AGENCY,
LENDING INSTITUTION. IF LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTITUTION.
GUARANTEETO
FOR S.C.D.H.S. USE ONLY , ADDITIONALs INSTITUTIONARE NOTS ORS SUBSEQUENT OWNERS.
• TEST HOLE DATA
UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY IS A VIOLATION OF SECTION 7209 OF
TEST HOLE #3 IN LOT 27 ON SAID FILE MAP THE NEW YORK STATE EDUCATION LAW.
( APPROX. 200'i- SOUTH & WEST OF LOT#3 )
COPIES OF THIS SURVEY MAP NOT BEARING
r EXISTING GRADE THE LAND SURVEYORS EMBOSSED SEAL SHALL
NOT BE CONSIDERED TO BE A VALID TRUE
�9 �, - •,' • \7�\�;�\\:�\\!`\„i/\\%i\ LOAM COPY.
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L„ , 7 a C.) , 17' GROUND WATER
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ti °'. I - SURVEYED BY '
STANLEY J. ISAKSEN, JR.
4 t ,r.. t,. , .1 ..:_. .v:; P.O. BOX 294
11: IV\ NEW1 UFFOLK, NY 11•'1,6
i 631 f73;-5:35
EN" 1D LAND S VEYOR
NYS LI''. NO. 492 3
NOTE: 1. 05 M FEBRUARY, 2001 ADD PROPOSED RESIDENCE 00C911