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ELIZABETH A.NEVILLE i .4% ; Town Hall, 53095 Main Road
TOWN CLERK P.O.Box 1179
CA
REGISTRAR OF VITAL STATISTICS k Southold, New York 11971
®� ���It� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER \,_ ®1 ... •®i�� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ���� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2758 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : DIANE & LEE RUDNITSKY
Address 1 : 1548 WILLIAM STREET
City St Zip MERRICK NY 11566
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 #R10-01-0243
Name Of Owner RUDNITSKY, DIANE & LEE
Mailing Address 1 1548 WILLIAM STREET
City St Zip MERRICK NY 11566
Property Address 1 550 ALBO DRIVE
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 3 lot 1 .000
Cross Street WELLS ROAD
Building Permit Number Cross Reference:
Issue Date: 3/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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1111`® - ? �®4
ELIZABETH A.NEVILLE 111�� T ,4 ; Town Hall, 53095 Main Road
TOWN CLERK
� ®eA �uK� ' . � P.O. Box 1179
REGISTRAR OF VITAL STATISTICS % �y;.' � ` P �� Southold, New York 11971
MARRIAGE OFFICER :....a it.0 Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER .C�d 1.7 �v 11 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER � .9" southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD A.. �""~�- •--
1} �� i ___.,_,
, tt"j - `� 1 a
TO: Southold Town Building Department iU1_11 MAR 5 2002 ,`1
FROM: Linda J. Cooper, Southold Town Clerk's Office iii:)-,: --,--- -n._J ,
DATED: March 4, 2002
Transmitted herewith is a copy of application No. 2863 for a Cesspool/Septic Tank Construction
Permit submitted by:
Diane and Lee Rudnitsky
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: ' e ' , i-
'rk‘ce•ZkeZ.4,
Signature
, 3/.."4".5-"A z_
Dated
J,
i
////IIIII.,'
.rOFFICE OF THE TOWN CLERK 11'',ODLKO''•TOWN OFSOUTHOLD OsN4 . Application No.o���
ELIZABETH A.NEVILLE,TOWN CLERK •,
1
P.O.BOX 1179 Construction e`er
SOUTHOLD,NEW YORK 11971 : p • rmn ;
VS WAlteration
Telephone 1--°• /.4„
irt: ' $10.00 -Residential
(G3t) 765-1800 - l �,�'�s $25.00 -Non-Residential
..�/o/'/
TOWN OF SOUTHOLD •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT ,
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 3/ )01-7''
B
APPLICANT NAME: PltINrovi�ce- & 1v!/TGL/` R ac/ t-r if-- z.9 k
y
APPLICANT ADDRESS: /s-yr lt//G- Is <
171(p-svi cL f r 56b
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
I -- S1,%41,-- IA-Al (y �) t /Ze)nA-N.
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
. OWNER OF PROPERTY: Tire) /1-L /7/1d
OWNER MAILING ADDRESS: /VW 6vr//i,.-" S'v--
f evviek, (1 cd d
OWNER PROPERTY ADDRESS: 55-O A-l.-( 13O 'DNA tc
L.ihivt .
TELEPHONE NUMBER OF CONTACT PERSON: 57e. q?,—//�y
TAX MAP NO. : Section /26 I vv Block 03,o v Lot O & / , c"-' `"
CROSS STREET: W82-LS 10A-10
BUILDING PERMIT NUMBER CROSS REFERENCE:
• /, i
ign=ture of . pplicant
•
RECEIVED BY: PS1- 4 •
Town Clerk's ffice
DATE: e! V d
•
4 . —~� Survey for:
- 1 , ARL DEVELOPMENT &
6OWelli• DIANE R UDNI TSI Y
(
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Town of
,ftEiii° ry0 ` ` �, `
••".....
` ,Ok'e//ir�9 Vy/Public K,G
Southold
�v" ` ;� ` ter) , Suffolk County, New York
. � /
so - _ S.C.T.M.: 1000-126.00-03.00-001.000
�IGN a / ® �. ` A ` �OWeI/ln9 W/Public lye ter)
.9 3 I ` o rfR MAIN `
\,. : S 3.46• / ve NOTES:
* i et4»3 `SOhe EDGE- C1,18 1 1. AREA = 17,379 S.F.
/ 0) cE°r Pa�MeNr 2. ■ = MONUMENT FOUND
/ n 3. REFERENCE DEED L. 12037 CP. 820
/ N / 4. ELEVATIONS SHOWN HEREON ARE REFERENCED
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TO APPROXIMATE N.G.V. DATUM (MSL 1929).__ i3 ���sO 007
Y O MON
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�'/ ����� -� sT- T-- __ __ �r� /v DATE: SEPT. 22, 2001
\ 9 Z / I ���1 / --100.0' MIN.— m ° SCALE: 1"=30'
/ - z� N I ��/ I ° /�� JOB NO:2001-400
\ p. / I / \ / •o ��` �`� .2
/ / I S��P of
I / O P51 $��_� �L
\ / 1 ` RC9)�yo°°� �- OC CERTIFIED TO:
\ pe // o oJ`'a0 a?s 4o? �� < ARL DEVELOPMENT &
/ / �O p DIANE RUDNITSKY
Lag f� Q CDP / pROP�R I `-to •� ^ S. L� I Q -1
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G3 Q / SR�i�' • I� 47 c = "C C>fi1
\1 0 / ��o� �� n �' TEST HOLE DATA tib_ '' rn
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rr. 7,9 p F ri r:9 \ .. . / IIQe- 3°e SEPT. 22, 2001 ,� Q
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F� G� CP w •\ / r I \ LOAM
_ - L -.'t A U I 3.3
'= �Y / II 44 \y LOAM DAVID H. FOX N.Y.S.L.S. #50234
� „` s / �J��O o(r�'e \d GRAVEL FOX LAND SURVEYING
rx9
569 o< F �,�0 4.5 Po BOX 224
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ca
\ O GrU MCOARSEEDIUM O
SPEONK, N.Y. 11972
Li. �j = Q \ < WE�� r ((� SAND & (631) 325-2902
, 1 �'�'� y Fl ; li v`V1r\�r� l0vrelG�a� GRAVEL
--' r\�� �� �.J `,J�$ p ` 12.0 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY
,� IS A VIOLATION OFSECTION 7209 OF THE NEW YORK STATE
F3 21 MEDIUM THE LANIDNLAW SURVEYORSSOF INKED SIS EALURVEY MAP NOT OR EMBOSSED SEBRING
AL
I l 0` SAND SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY
4 `.) r to
CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE
17 0 PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS
BEHALF TO THE TITLE COMPANY. GOVERNMENTAL AGENCY
AND LENDING INSTITUTION LISTED HEREON . AND TO THE
ASSIGNEES OF THE LENDING INSTITUTION CERTIFICATIONS
' �_-- ..�... ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS t
OR SUBSEOUENT OWNERS
DWG: 2001-400