HomeMy WebLinkAboutKelly (2) /,�®OFF04,
ELIZABETH A.NEVILLE �� 17Z f:A : Town Hall, 53095 Main Road
TOWN CLERK ; ce, P.O. Box 1179
IVO
REGISTRAR OF VITAL STATISTICS '�� Southold, New York 11971
MARRIAGE OFFICER �` t,* �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER �, Q( �®',�� 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. 2538 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : BARBARA P. KELLY
Address 1 : 7425 BAY AVENUE
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 #R10-00-0266
Name Of Owner KELLY, BARBARA P.
Mailing Address 1 7425 BAY AVENUE
City St Zip CUTCHOGUE NY 11935
Property Address 1 7425 BAY AVENUE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 104.00 block 4 lot 29.000
Cross Street BROADWATERS COVE
Building Permit Number Cross Reference:
Issue Date: 3/27/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH.A. NE.VILL -'-�_ d 14-„�# Town Hall, 53095 Main Road
TOWN CLERKOFJc- , f P.O. Box 1179
REGISTRAR OF VITAL STATISTICrgk
S �` Southold, New York 11971
MARRIAGE OFFICER �0. of (63 Fax(631) 6765-1800
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RECORDS MANAGEMENT OFFICER `� F. Telephone
FREEDOM OF INFORMATION OFFICER "51 0,�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: March 15, 2001
Transmitted herewith is a copy of application No. 2626 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Barbara P. Kelly
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.
ignature
Dated
1 Y�f f �a •
OFFICE OF THE TOWN CLERK ���c�0�K
TOWN OF SOTJTHOLD ��1; �OGy Application No.?baro
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 % Construction
SOUTHOLD,NEW YORK 11971 ; v rn
N Alteration
Telephone �0`r.��' $10.00 - Residential
aggl(631) 765-1800 = l° 90 $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION •
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 3 of
APPLICANT NAME: ibtolp.gbARA (4ic-9,
APPLICANT ADDRESS: (1(-M 6A-y Au it •
o. Li-re (4136c-'e cJ ((f3.5—
SEPTIC
(f -SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
OW
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY:
OWNER MAILING ADDRESS: rl-Mc P .
CLI - .e cnL-i I«3
1/4,4075-
OWNER PROPERTY ADDRESS; 68Y IAVE
Ccrc 46 u F
TELEPHONE NUMBER OF CONTACT PERSON: C3(— /).31-1- a077
TAX MAP NO. : Section \bL Block L' Lot
CROSS STREET:
BUILDING PERMIT NUMBER CROSS REFERENCE:
PcN
Signature of Applica t
•
RECEIVED BY: }
Town (Clerk's Office
DATE: l0(
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'01 ,I1\N 26 P1 : 6 • n a;;
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./.9w9---/7 84/ -5,5 PLEASE NOTE
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1/4kMinimum distance between well
N , ' • a - and cesspool is to be 150 feet.
410cl. IT
,7 V . �i \.9 SUFFOLK COUNTY DEPART OF HEALTH SERVICES •
a
07 r P,eN PERMIT FOR APPROVAL OF CONSTRUCTION FOR A •
4; eferric, SINGLE FAMILY RESIDENCE ONLY
try6rw 1,
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I i c DATE ' 01.��,
gyp` APPROVED ,
C_Ip.',3). icze-
6 m cbFOR MAXIMUM OF..4.-..DE r.civ S
o_ EXPIRES T'f E'YEARS FROM DATE OF APPROVAL
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unauthorized alteration or addition
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to this survey Is a violation of
--__ .44,7/AZ Section 7208 of the New York State
docadon Law a
C,,ples of NS survey map not beterKi
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the land surveyors Inked seal d
�,�--*` saded shall notbe consktwed
44ZW dF/Yl pppv valid true not./ Guarantees Indicated hereon shall tun
only to the person for whom the sunieY
Is•prepared,and on Ns behalf b tiro
governmental agency and t
1 lending Institution Aced hereon endto the assigneelending Institution. 1
Guarantees wee not of trlransferable
to sddidonal Institutions or subsegwnt ,
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