HomeMy WebLinkAboutReynolds ELIZABETH A.NEVILLE �� � Town Hall, 53095 Main Road
TOWN CLERK ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER �� O � �, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER -_.®� ��rrZZ,, �v �i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ED ,/��
OFFICE OF THE TOWN CLERK
SOUTHOLD ' 1TT I' 4ROSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2664 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : RICK & GAITRI REYNOLDS
Address 1 : 73 JOYCE DRIVE
City St Zip RIVERHEAD NY 11901
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 #R10-01-0187
Name Of Owner REYNOLDS, RICK & GAITRI
Mailing Address 1 73 JOYCE DRIVE
City St Zip RIVERHEAD NY 11901
Property Address 1 LUTHER'S ROAD
City St Zip MATTITUCK NY 11952
Tax Map No. section 106.00 block 9 lot 7.007
Cross Street MILL ROAD
Building Permit Number Cross Reference:
Issue Date: 9/25/01 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE �� � o Town Hall, 53095 Main Road
TOWN CLERK ® 4 P.O.Box 1179
REGISTRAR OF VITAL STATISTICS tx' ign
Southold, New York 11971
MARRIAGE OFFICER . ��, Fax (631) 765-6145
RECORDS MANAGEMENT OFFICER '�,/� $ 'i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �D'�
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 24, 2001
Transmitted herewith is a copy of application No 2754 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Rick and Gaitri Reynolds
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 1 ation 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.
Signature
a
Dated
_ THE TOWN CLERK ,'''Of IlL l/
TOWN OF SOUTHOLD 'i'�c �1 CQG Application No. 2X5771
F1,17ABETH A.NEVII"i.F,TOWN CLERK : 0 /
P.O.BOX 1179 Construction
SOUTHOLD,NEW YORK 11971v T
Alteration
Telephone ,� sbQ� � $10.00 -Residential
(631) 765-1800 -_j1 it ' ,��' $25.00 -Non-Residential
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• TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT i
SEPTIC TANK or CESSPOOL
Permit No. •
Fee .$
DATE 7/410) '
APPLICANT NAME: �Ci�� ,4.s4✓ao. krolis
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APPLICANT ADDRESS: ' 1 , 'Q Cie
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SEPTIC ' CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR
c 5� ALTERATION
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LOCATION MAP: Must, be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION 12 A TERATION:
OWNER OF PROPERTY_. & C4CA IiGI��
OWNER MAILING ADDRESS: 'j S rte_ .i -
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OWNER PROPERTY ADDRESS: - . L)4dk'ts ad . (Kin 11J k
TELEPHONE NUMBER OF CONTACT PERSON: CS I- 7a7- 3 531
TAX MAP NO. :, Section , L Block Lot 7,/
fV1I_ ) •CROSS STREET: GA )
BUILDING PERMIT NUMBER CROSS REFERENCE:
tscQ.LIYY\, f
Signature of AlapIicant,
RECEIVED BY: /4- 1 -
Town lerk's Office
DATE:
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ELEVATIONS IN ASSUMED DATUM
Unauthorized alteration or addition to this document is a violation of Section 7209
" of the New York State Education Law SURVEY OF:
Certifications indicated hereon shall run only to the person for whom it is preparedLOT 3
and on his behalf to the Title Company,Governmental Agency and Lending
Institution listed hereon,and to the assignees of the lending institutions or M I NOR SUBDIVISION PREPARED F O R
subsequent owners
Copies of this document not bearing the professional's inked seal or embossed STANLEY SLEDJEDSKI AND HELEN SLEDJESKI
seal shall not be considered a valid true copy
The offsets[or dimensions]shown hereon from structures to the property lines are MATTITUCK TOWN OF SOUTHOLD
for a specific purpose and use and therefore are not intended to guide the erection of i
fences,retaining walls,pools,planting areas,addition to buildings or any other SUFFOLK COUNTY NEW YORK
construction i
Tohe t existencce e df right of ways and/or easements of record,if any,not shown are SURVEY DATE: 7/24/01 SCALE: 1"=50'
nCERTIFIED ONLY TO: oF SEW
RICK AND GAITRI REYNO F' YO DESTIN G.GRAF
' oiE3TIN�.GRAF�� LAND SURVEYOR
a . ..1. �•,y,,•�1 ? • 73 Woodlawn Road
.C, ..►r',. ai. N Rocky Point, N.Y. 11778
By DESTIN G GRAF N Y.S LIC No 5006 �0 � N5• #050087 y 631-821-3442
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