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•ELIZABETH A.NEVILLE �`, Town Hall, 53095 Main Road
TOWN CLERK ® P.O. Box 1179
REGISTRAR OF VITAL STATISTICS �'�� Southold, New York 11971
MARRIAGE OFFICER = Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER --_ 00 Telephone (631) 765-1800
_
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
SOUTHOLD rikiaiSN EaritalaRTIM R SAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2631 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : SUSAN BECKER
Address 1 : 350 KENNY'S ROAD
City St Zip SOUTHOLD NY 11971
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 #R10-00-0065
Name Of Owner BECKER, SUSAN
Mailing Address 1 350 KENNY'S ROAD
City St Zip SOUTHOLD NY 11971
Property Address 1 WELLS ROAD
City St Zip PECONIC NY 11958
Tax Map No. section 86.00 block 1 lot 9.006
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 8/08/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE I 1 4 : Town Hall, 53095 Main Road
TOWN CLERK % Co - % P.O . Box 1179
0 % Southold, New York 11971
REGISTRAR OF VITAL STATISTICS Fax(631) 765-6145
MARRIAGE OFFICER ``®eji s��11,
- RECORDS MANAGEMENT OFFICER s'--74941
_�Q� +01,1 Telephone Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ---....0'''
' .0'''�',
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building bepartment
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 31, 2001
Transmitted herewith is a copy of application No. 2719 for a Cesspool/Septic Tank Construction
Permit submitted by:
Susan Becker
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: I/
APPROVE
DISAPPROVE
Comments:
Signator
Dated
r
OFFICE OF THE TOWN CLERK i '�rrr�rr.r.„���; .
TOWN OF SOUTHOLD ,'' OC,��I OjK`►O�_ • Application No.r-271
ELIZABETH A.NEVILLE,TOWN CLERK
P.O.BOX 1179 < ; Construction
SOUTHOLD,NEW YORK 11971 o • T
to Alteration
•
Telephone s �Q� . $10.00 -Residential O`
(631) 765-1800 -_.'1 �do' n $25.00 -Non-Residential
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
•
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE (JJy .3o` zoo J
APPLICANT NAME: 3(,{s ah L , .8ec _
APPLICANT ADDRESS: 5b K n n\ d
5o(,c_ id r l 9:7-i
SEPTIC CESSPOOL\j
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
re
•
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: •
• OWNER OF PROPERTY: 64/5,n L . /kv
OWNER MAILING ADDRESS: ;50 rent'-) "c Rq
sou v-he 1 /
OWNER PROPERTY ADDRESS: I A efts oa&..
Peso n I& �-' . 1 I R51.
TELEPHONE NUMBER OF CONTACT PERSON: 63 /- d'b' '
TAX MAP NO. : Section e 6 Block O / Lot 9. 6.,
CROSS STREET: but t
BUILDING PERMIT NUMBER CROSS REFERENCE: .
,/14t o )
Signature of A plicant
•
RECEIVED BY: /i%_-4111
own Clerk's Office
DATE: 7/3Q/6/ •
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TEST HOLE SECTION SEWAGE DISPOSAL SYSTEM ; '
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EL=130 EL=118 EL=,10 EL=105
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SUFFOLK COUNTY DIPARTMENT OF HEALTH SERVICES
PERMIT FOR APPROVAL OF CONSTRUCTION FOR A r F�N�E .
SINGLE FAMILY RESIDENCE ONLYRP,\�
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DA 01 H•S• F• . AtO -c)Z 00CcsS' '`P
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APPROVED Ni S ,
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FOR Maximum OF BEDROOMS_��� N
- EXPIRES THREE YEARS FROM DATE OF APPROVAL \'
3325 12 0 1
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20' I '1 % 13 I g 3050' B F�EL-17.ON,s so'� �•, ,%3 I LIMIT OF FLOOD ZONE "AE" BASE
- -------- --- -------k-------- --- 8-----'1 n' 6 .700.... a LP----F-- -
_ �+ ELEV 8 AS SHOWN ON FLOOD
EAATH ROAD"__,-- so''_ DECK Bili `�_ A8� __I -_ _ INSURANCE MAP NO. 3610300162
o G LAST DATED MAY 4, 1998
I LIMIT OF CLERING
COL
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• MAINTAIN A 65' UNDISTURBED
` (8� (�O NATURAL VEGETATION BUFFER
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LINE OF HAY BALES y� ~�1
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LANDWARD LIMIT OF TIDAL;
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•, 11 WETLANDS AS DET MINED
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A PROPOSED WOOD ., 1 W71 :t'
-"-'- CHIP PATH i i', FOR DETAILS OF PROPdSED '3 �-
-- - ___ -• �'I '\WOOD CHIP PATH, FIXED\WALK (-)- 1u
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' -- BY'SEA LEVEL MAPPING,',LAST
1' DATED-,09-30-00, •-
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WALK ds DOAK
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RICHMOND
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