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ELIZABETH A.NEVILLE ��� Gia; Town Hall, 53095 Main Road
TOWN CLERK k o P.O. Box 1179
Southold, New York 11971
vo PA
REGISTRAR,OF VITAL STATISTICS ® � Fax (631) 765-6145
MARRIAGE OFFICER ,L
RECORDS MANAGEMENT OFFICER `= '�®� y� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER "�" �� southoldtown.northfork.net
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2759 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ELIZABETH THOMPSON
Address 1 : BOX 806
City St Zip NEW YORK NY 10012
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 #R10-01-0221
Name Of Owner H I NSCH, ELLEN
Mailing Address 1 333 E 46TH STREET, APT 1F
City St Zip NEW YORK NY 10017
Property Address 1 PECONIC BAY BLVD
City St Zip LAUREL NY 11948
Tax Map No. section 126.00 block 10 lot 16.000
Cross Street BRAY AVENUE
Building Permit Number Cross Reference:
Issue Date: 3/11/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
' I/�' s,���®g11FF0(�c �S
ELIZABETH A.NEVILLE kii.1® Gia; Town Hall, 53095 Main Road
TOWN CLERK ® - P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ‘ ® etw` �� Fax(631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER _��®� ��®��0�' Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER��,,.9" southoldtown.northfork.net
OFFICE OF THE TOWN CLERK rT - ----_ .
TOWN OF SOUTHOLD _ T
R 5 ill" !
TO: Southold Town Building Department ;`. i
_ t
6! DC , ..-_.3
FROM: Linda J. Cooper, Southold Town Clerk's Office T ' ''
' ..,- i t.or n
DATED: March 4, 2002
Transmitted herewith is a copy of application No. 2864 for a Cesspool/Septic Tank Construction
Permit submitted by:
Elizabeth Thompson, Architect
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 `�
C7�-�! \
Comments: .
�
7/r(e-e2Or
Signature /
DV Off dZ
Dated \
OFFICE OF THE TOWN CLERK �'� �`1 0 IC
,
TOWN OF SOUTHOLD �5QQG Application No. o6`-rl
F117ABETH A.NEVILLE,TOWN CLERK ►��0 '�1 : /
P.O.BOX 1179 Construction �/
11
SOUTHOLD,NEW YORK 11971
N • ^_' ; Alteration
Telephone ‘''•V 'I'
�QIi1, • $10.00 -Residential t/
(63t) 765-1800 =�01 �do' $25.00 -Non-Residential
•
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE SMOZ,
APPLICANT NAME: ElA7,14SKIN iH p 0.11/4) keg'TELT
APPLICANT ADDRESS: Z�jO WIEI? Q. '-A• s $O(o
w%1 NY( 1 e'en
Z-
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION 'OF PROPOSED CONSTRUCTION OR ALTERATION:
• OWNER OF PROPERTY: cu,EN NSc.N
OWNER MAILING ADDRESS: 337, E 4'6, ST , ATT. IP
1\)%1 N`l '&017
OWNER PROPERTY ADDRESS: 1?ECm1itCr 'g�,`1 $�u� LAuR.ec_
TELEPHONE NUMBER OF CONTACT PERSON: AfrucssM' 1 Ztz - .i 4 -7lc
TAX MAP NO. : Section 1 242 Block tb Lot I �,
CROSS STREET: $e,I4-4 1.k—
BUILDING PERMIT NUMBER CROSS REFERENCE:
A/5k, ( 1.4.+,4414
Signature of Applicant
•
RECEIVED BY: TOOD1-0.):(-31-/\
I Town Clerk's Office
DATE: 3 / fO�
F
U ZZ ZZ N
Foo,.,
Young de Young, Land Surveyors ""�g
Pig
400 Ostrander Avenue, Riverhead, New York 11901
631-727-23030
NFig
Alden W. Young, P.E. & L.S. (1908-1994) o ��
Howard W. Young, Land Surveyor y�o
?
i Thomas C. Wo/pert, Professional Engineer =
.a
SSUFFOLh:L.:OUNTY DEPARTMENT OF HEALTH SERVICES
E PEP.MI► F,orAPPROVAL OF CONSTRUCTION FOR A
•
SiNGLL""• FAMILY RESIDENCE ONLY
DATetz:16(° [�^ ear . I o— 0 —V
•
APPROVED /
FOR MAXIMUM OP 1'1 Br.DROOltir
•
EXPIRES THREE Y 'ARc "TROY
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HEALTH DEPARTMENT USE Ez-r;
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TEST HOLE DATA
JUNE 11, 2001
0 0' 0
•
BROWN
LOAMY
SAND
(SM)
2.0'
PALE
BROWN
FINE TO
MEDIUM
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NOTE oge
AREA = 52,783 SQ. FT. gra
• VERTICAL DATUM = N.G.V. DATUM (M.S.L. 1929)
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