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ELIZABETH A.NEVILLE ��� ��d; Town Hall, 53095 Main Road
TOWN CLERK ; e a P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ,�� Southold, New York 11971
MARRIAGE OFFICER �o .; N �1
Fax(631) 765 6145
RECORDS MANAGEMENT OFFICER 4 Sr iii Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER am 9"
OFFICE OF THE TOWN CLERK
SOUTHOLD IVASTEMA9CEIRITICRBOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2670 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HARMONY HOMES
Address 1 : 9 SHORE ROAD
City St Zip MOUNT SINAI NY 11766
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 #R10-99-42
Name Of Owner PALACINO, SALVATORE & SUSANNE
Mailing Address 1 1 WHEELWRIGHT WAY
City St Zip SMITHTOWN NY 11766
Property Address 1 790 OAK STREET
City St Zip CUTCHOGUE NY 11935
• Tax Map No. section 136.00 block 1 lot 38.000
Cross Street PIERCE DRIVE
Building Permit Number Cross Reference:
Issue Date: 10/18/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE �� Town Hall, 53095 Main Road
TOWN CLERK ; a P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER s 1� Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ®� ®�i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER
_R ,
OFFICE OF THE TOWN CLER 1_1 i - ;I I
TOWN OF SOUTHOLD
" C 2001 L)
TO: Southold Town Building Department L
Tc.--
FROM:
•' 'FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 3, 2001
Transmitted herewith is a copy of application No. 2761 for a Cesspool/Septic Tank Construction
Permit submitted by:
Harmony Homes
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 loc tion map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments: iii-w c' /.€4.‘OZ'
7/,‘,/,q4
Signature
/d/e/5/4/
Dated
V
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r
OFFICE OF THE TOWN CLERK
I
/
TOWN OF SOUTHOLD �+Q • , Application No.QplELIZABETH A.NEVILLE,TOWN CLERK •P.O.BOX 1179 Construction
SOUfHOLD,NEW YORK 11971T/ Alteration
Telephone Qom/ • $10.00 -Residential
(631) 765-1800 = �1 �,�' $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT - ---.
APPLICATION
OCT 2 2001 •
for '�',or��a¢ y°
Clerk
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE / /2-/C5
APPLICANT NAME: r U Ce 1. ri•Ava N N h .r,P 14- jug(
APPLICANT ADDRESS: 9 sftRE eau. cif
!'2T. 5,1 iA-f / ( 77 6
SEPTIC 7 CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
ew Res-[4 �A e
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION':
OWNER OF PROPERTY: S4,1 V'ako N".-30 j1j5LC. Pt 570 h \(�
� a e e 1,1 a
OWNER MAILING ADDRESS: . C,JI�t,221 � kJ L.30-41
ern-cT� � A � W__ (, L( 7
OWNER PROPERTY ADDRESS: v75o Oc_k c -re€-
C t
+-C--A\ 0 u ) NY.
TELEPHONE NUMBER OF CONTACT PERgON: I c5 ze G
TAX MAP NO. : Section r3 !o Block I- Lot 3 g
CROSS STREET: V -
BUILDING PERMIT NUMBER CROSS REFERENCE: .
Signature of Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
-,�
'SURVEY OF LOTS # 34-3'7 SURVEYED OI-13tiaa
/ MAP OF EUGENE HEIGHTS exie�1.g TAX LOT REV. 02-25-aa
FILED WITH THE COUNTY AS # 556 pave e`" • N AMENDED o3-O5-aa
SITUATE: GUTGHOGUE ���rC� ex,yt,ng o4-2a-aa, os-l7-aa,
TOWN OF SOUTHOLD o6-2a-aa
�J W ` C E SUFFOLK COUNTY TAX #
SUFFOLK COUNTY, NY 1000 — 136 — I — 38
S CERTIFIED To:
Test Hole SAL PALAGINO
obtained 01-13-61°1 w t• SUSANNE PALAGINO
o
at High Tide j i'' i
(not to scale) / ,
o 0' I existing 1eUi
ropwn reit pWe111 g -
0 5' ' / tU U i
4 ' 4
,y0' + I r I l a
Loan 5°'+/- exiet'rg 288.73' 1 , I 4 4 'I, i;,''
Sept,c - clnverou' ' r - ✓/c
existing • Ewyt ^ - st^ne r li it 4 4 l�,,'„P °
3 0 ^ re1E .aroge ! 9-"ex�sti o _ ,off ^ I I T r fF
1
U 30 �7 001'10"E _-- - - { 1_
4
exEst�ng Ldt # 8_- 1�gT - { -(- 'From.,'' �� I a' 4_4_4
_ — — —
at�c _ _ - ,. .--__—_i-4-1 ye -ia 100 Jt I f 1 `'F -�— 4 '4 1' '
sob 9e •
�, * tion F F wetlands St `, - �J I — — — — ','
Gravel _ 3 100'+sap N ® .a}�` P��sS\ I 21'1'4 4 l''
v �r�\- Proposed 0 , �>9 v i.� / ; 4 4 `� �'
'� Ve of water1
ii r `t , g //o �, e/
•
7 0'
LA
OO Proposed /y•
� �'�%�)
® t!1 _ — — Pervious U1 of' /d' ' r� ° ,
pO Drive r,1 /0 - - '4(-Se'`' /'/0a 1 4 /,
coarse Iri i� LOt u O`' h
o_\___ ___\___
\, -�; ' •So*zw +Ppsr.ecl Ht se , f :/:" 4 ,%��
clean 1 st,�q ole / �.7 epff f '% 4 — —
' r_ ii i ii iii /N ,° ii °-"'!�.' '0'' '�' ,
aa„e — N P iii iiii45' /w - i '1b` 4 ✓�` • �'
N �;%
'' S0 191,4eill g �' � ti�
of 35 5 O O a --"- -"- �/� �; %�� ,,' ' ' ;:1
6fvlpd 17 2 o ;. o i,,; ° Dc ,
PlatorI
oleo" 1 `}� 6'- 0�.,
aa� 19 5 ____aver" 'pq5/ , ✓Et 4 i.y T7.-'C3 SCO DEPP E 'O HEALTH SERVICES
O Lots 34,' rtUhI1e Q------1::
- g0� / 1 4,4
/ to f"�°l existing , deck ZO7� / F 'a oa ROV L?s iiS UcTIO FORA
NOTES: \ � ggZ°011* W pWelling , '\ i , :�..
-- t, ',�.` oporot1n i ...1�91L.7.3d£zo.t�d?`.:ffi.da;91t%Ar. Fe1°+iS'1Xd@
3^
is-..,.,.,„,, yry yq p p, (/r '` a /i 4 'yi
• 9
MONUMENT FOUND ti
' L-•L # o Ic at on eF pt,c g r)'a b iu ®�Yd ® HS 1�91C.JV--
4td> 1 Jl,l t� yl / ` y L.��
of extst�ng .. IW�.--9 «.s"?
ex,s1 Vt'ng well _ (---c----
•^e ""?p�,r
PIPE FOUND J' 0 well a' '�/E�9 r.,/16-
ti ' _` ,;tea Y
25'+/ i 4 .. a d = t}� i HEDGE ewsting '6�R 12f3k31 '�i 4/� *'t 1 --1
Sept5°,+l- ( S TH EE YEARS FRO DATE ,rte- € •`�,,
AREA =2-1,331 SF OR 0.63 ACRES U �� �R®��`I°
-:::::::a _ '': '
o,Prox ..,m
ELEVATI ONS REFER TO MSL NGVD '2a ap0ax 4pt;�y�;ead _ _. _- . :.—,� > _...��
a ot,a,, Approved in accordance I t Scar of Review ._<.
of ewsting -�i'- .-.'
well ui F:0.ement I Ll. r—y 4F
` < determination dated 'Unauthoric--,,,r71Uoteeration addition to a survey
determination li V i MH map bearing d�icensed landsurveyor s seal is a
violation of section 7209, sub-divisions 2, of the
' ��_ ///f�1••
New York State Education Las•
OF NE
Only copies a from the original of this survey
mpedetl with an original coni of the land surveyor's
III,`� C. EH( `_ stamped seal shall De considered to be valid true
Q � . copies'
II•, �0�� �9 O i 'Certificaytionwass indicated hereon signordanceify twithhat thethis
surv'\{'l" "(5 t iotingeCade of rPractleeinfor cLand Surveys adopted
ex-
0 •� by the New York State Association of Professional
apptax ) Land Surveyors good certifications shall run only
�oGYGt , ' ` to the person for whom the survey is prepared,
^F a+�st�ng , ! 1- and on his behalf to the title company governmen-
"y11 F1z e,,=ercei: 1 > tai agency and lending institution listed hereon and
9 to the assignees of the lending institution Certifiea-
, 41 r- li�' J ; tions are not transferable to additional institutions
U �`�4,,c, 4/0111.1°9'PJ</Or
ocprox I
locot,on �A N Sv /�
c ewsting ••
5epttc '
N Y.S LIC NO. 50202
GRAPHIC SCALE 40' 6OHNSC MAIN ERSRLANRS LAND SURVEYOR
RIVERHEAD, N.Y 11901
369-8288 Fax 369-8287 REFERENCE # 99-103D