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ELIZABETH A.NEVILLE �� � Town Hall, 53095 Main Road
TOWN CLERK
P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® --170 orIFT
,
MARRIAGE OFFICER � Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � ®d Vo���� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �i��
OFFICE OF THE TOWN CLERK
SOUTHOLD11(ffigeTEMPEURTIMIOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2669 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : PECONIC DESIGN & CONSTRUCTION
Address 1 : PO BOX 1251
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 #R10-01-0193
Name Of Owner DELUCA, N. CHARLES
Mailing Address 1 PO BOX 1251
City St Zip CUTCHOGUE NY 11935
Property Address 1 57908 MAIN ROAD
City St Zip SOUTHOLD NY 11971
Tax Map No. section 66.00 block 2 lot 2.002
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 10/18/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
" - 3
(...6(71
/ELIZABETH A. NEVILLE `
,04_, •
Town Hall, 53095 Main Road
TOWN CLERK ; ";11.1 , P.O. Box 1179
REGISTRAR OF VITAL STATISTICS
` em, �V�3 ��`� � � Southold, New York 11971
MARRIAGE OFFICER : ®; , � �1 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER _ "�% ,ss�, � d/, Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER `2�'
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 1, 2001
Transmitted herewith is a copy of application No. 2760 for a Cesspool/Septic Tank Construction
Permit submitted by:
Peconic Design & Construction
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
DISAPPROVE4th:;(
Comments:
Signature
/o,//o/
Dated
OFFI;�'EOF E TOWN CLERK e'ei ��FOj -�n/�j�j
TOWN OF SOUTHOLD %�t.�� KCQGy Application No. /`�[/�
ELIZABETH A.NEVELLE,TOWN CLERK
•
P.O.BOX 1179 � y Construction
SOUTHOLD,NEW YORK 11971 =v •
:=1Alteration
.
•
Telephone $10.00 -Residential
w
�,� �0 �/
(631-) 765-1800 = ®_ 2 Alt$;0'..
• $25.00 -Non-Residential
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for ECE1vED
CONSTRUCTION or ALTERATION PERMIT QCT i 2001
SEPTIC TANK or CESSPOOL ..avralmiluf goyim Clens
Permit No.
Fee .$
DATE /pa/
APPLICANT NAME: ,/1C NT6 ,375/Wri (ov,Ska€7.1c,e,
APPLICANT ADDRESS: ,Fox /257
(i.101/14' //3f •
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/" fW 51/4)0r/, .40/. �� /740e-e4--
.
LOCATION
7®o 4--
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
. OWNER OF PROPERTY: ,� e%i, /,g eiliteisa
OWNER MAILING ADDRESS:
OWNER PROPERTY ADDRESS: 7 /O /i9//v ,
Sz(9 , <<9-
TELEPHONE NUMBER OF CONTACT PERSON: 7 0
TAX MAP NO. : Section (p Block Z Lot .2,2
CROSS STREET: ,(/ o2C-
BUILDING PERMIT NUMBER CROSS REFERENCE:
Signat of Applicant
RECEIVED BY: •
Town Clerk's Office
DATE:
SURVEY OF LOT 31I
MINOR SUED IVISION OF FOR /� n,
N. GHARLES DEL.UGA *- ®a %``� 1,,
2
SITUATE: SOUTHOLD �j ��"�4 40.
TOM: SOUTHOLD — '"k°7-7
F 25
SUFFOLK COUNTY, NY P�
SURVEYED 08-23-0I / /; ; ,'
,
,
SUFFOLK COUNTY TAX # • „ /
,`r ;
1000-66-2-2.2 / 0�/, ;;;;;
CERTIFIED TO:
PEGONIG DESIGN B GONSTRUGTION GORP. -„, / /4)1 0¢-��„��h .,��,
�p ' ;I,/ ,'
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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES �p Z' ; ;
PERMIT FOR APPROVAL OF CONSTRUCTION FOR AQ�';ice dor
Test Ho4e.M SINGLE FAMILY RESIDENCE ONLY /
from Filed Map - . 'V ,, L,
Topsou /� r: '1•'0' �T
I. DATE ) ( I H.S. EF Rio —o -J//9
APPROVED ( a�,yo
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FOR MAXIMUM OF iti BEDROOMS ”
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EXPIRES THREE YEARS FROM DATE cyF APPROVAL '
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Nen York State Eduwton Lary'
MONUMENT !(Q� o y copies rrom tb orghai or mis s�ey
p� stomped ail sshall be considered to be nandytne
p PIPE x cat this
FEMA $1��3 i 1 Ir ENGED TO 'Certifications ueaa ee hereon signifyM m4
AREA = 81,881 SF OR 1.88 ACRES l rrey;a4prepe ed acearda ee ,, e.-
ELEVATEgNei ED TO NGVD '2q hL�wee r'acNae re Laed s,.,shall
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G1 Ne New Yat State As4ocblbn of Rofcss�orml
Lmd Surveyors n Sad ceche a roes 5 p rpn only
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tal SHOWN REFERENCE NGVD '2 R
one agency ore le to the compay herernmen-
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Moro ore not transferable!o oddRimol MLIlvtlons
LIMITS OF TIDAL WETLAND BOUNDARIES A5 �,T
t
SHOWN WERE ANNOTATED FROM NYSDEG A l y ri 03 j i 0 lin s . l'� C e E+ 'LE.'h S S RVEY0 l;
TIDAL WETLAND BOUNDARY MAPS Q A I l
031 6 EAST MAIN STREET N.Y.S.LIC.NO.5&02 t
GRAPHIC SCALE 1"= 60' '' RIVERHEAD,N.Y. 11901 REF.\\Hp server\d\PROS\01-116D.pro
369-8288 Fax 369-8287 '
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