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ELIZABETH A. NEVILLE 161&
• :41Town Hall, 53095 Main Road
TOWN CLERK ; co ; P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ',i Southold, New York 11971
MARRIAGE OFFICER � efv � Fax Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER =_ ®� *be"� 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. 2771 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : WARREN WALKER
Address 1 : 148 CENTRAL AVENUE
City St Zip GRENEPORT NY 11944
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 #R10-99-0102
Name Of Owner WALKER, WARREN P
Mailing Address 1 148 CENTRAL AVENUE
City St Zip GREENPORT NY 11944
Property Address 1 375 SOUTHERN BLVD
City St Zip EAST MARION NY 11939
Tax Map No. section 21 .00 block 3 lot 27.000
Cross Street ROCKY POINT ROAD
Building Permit Number Cross Reference:
Issue Date: 3/21/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A. NEVILLE 0�k4 4 ;
2own Hall, 53095 Main Road
TOWN CLERK % CO® % P.O. Box 1179
Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ;`61 Mkt. Fax (631) 765-6145
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER =__�®1 $ ,,• Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ������,,��'� southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD f-- - .
TO: Southold Town Building Departmentfl � � '`
\ C', ; MPR ‘ 2 `
FROM: Linda J. Cooper, Southold Town Clerk's Office ! i,; �_
DATED: March 12, 2002 k
Transmitted herewith is a copy of application No. 2869 for a Cesspool/Septic Tank Construction
Permit submitted by:
Warren Walker
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: N/i a,./ / 'r.-
j/ .
7/6.4-'4
Signature
,&'50/27:;/2--
Dated
•
OFFICE OF THE TOWN CLERK ,,,, „,,,CO
S�FFOLkc'
TOWN OF SOUTHOLD ;' -=
FT.I7ABETHA.NEVILLE,TOWN CLERK
4 #
P.O.
: 0�: Application No.��S�9
P.O.BOX 1179 : Construction
SOUTHOLD,NEW YORK 11971
Alteration
Telephone _O,f„ .0.0” $10.00 - Residential
(631) 765-1800 _
-WO/ 4t , ,�
$25.00 -Non-Residential
TOWN OF SOUTHOLD •
e •
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
•
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee .$
DATE 0?-,? -e) .:;2
APPLICANT NAME:JQ`�Ce h /t: r
APPLICANT ADDRESS: /48 Cey Ito ( r4Ue .
-teeviPor Jo.? ff 4/V
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATIONe
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: 6-)arPy
OWNER MAILING ADDRESS: /4' Cc
CPP v1 p6.4 .43,5- 119 p'
OWNER PROPERTY ADDRESS: g7S Sr,ei7L/le 13(vc).
TELEPHONE NUMBER OF CONTACT PERSON: /77 - Q/z--P
TAX MAP NO. : Section/DO p Block I Lot O 2 - 7
CROSS STREET: 120cky 090;,0-1 Poc.d
BUILDING PERMIT NUMBER CROSS REFERENCE:
•
Signat re of Applicant
RECEIVED BY: /11/
Town Clerk's Office
DATE:
REV
JOB NO. 99-26HOUSE 1OCTAX I.D. No. 1000-21-03-27
f
,
TAX LOT 25 TAX LOT 15
OCC RES VACANT
. WELL/SEPTIC NOT FOUND
N 89°57'40"E 125 19'•
I
105.0 !i
50'ROW TO 102 4
ROCKY POINT ROAD
I i 50'RIGHT OF WAY
,. _ DRIVEWAY
100' - r
•
PROPOSED _ C-: <
• SINGLE FAMILY :,. : +
DWELLING GAR it 1` , --
, '
GAR1060
Iwai _ µ:+ I
SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES 37' i
I IPERMIT FOR APPROVAL OF CONSTRUCTION FD='':A ; 36 0 I
N -LE FAMILY RESIDENCE®ia1LV Z w
j W _ SEPTIC 0
..iy/
LOVED
OEX O
...- . .. : �'
A I
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FOR MAXIMUM OF.�.BEDROOMS o 0
EXPIRES U,YEARS FROM DATE OF APPROVAL < o
' i / r iZ7LP
rA7/3 e 4 IX
I 5P 4-e-‘( -3/ -7°2-- /dam OS
�y
Ni. LP
11,v/� 6x
�� 'so.
WELL �! P9 (iR
cis „
I 1
1g0 N1F DZENKOWSKI Co
OCC RES N
1, x 1I
WELL 1
'
X 1 LOT 3
O 1 OCC RES
.. 0 TIE 312,51' 1i, PROPOSED
WELL
' 111.5 108 1
IV\
S 86°49'20"W 125.00'
SOUTHERN BLVD [ 50` ] 110.9 1072
1
I
1 .
LOT 15
LOT 1 OCC RES
OCC RES WELL NEAR ROADLINE
' 1 RIGHT OF WAY WELL NEAR ROADLINE
LIBER 6865 PAGE 260
SEE FILE MAP FOR TEST HOLE INFO
1 ELEV IN ASSUMED DATUM I
I FILE MAP No.5621 7/30/71
Unauthorized alteration or addition to this document is a violation of Section 7209
• of the New York State Education law SURVEY OF. LOT 2
I Certifications indicated hereon shall run only to the person for whom it is prepared
{ and ort his behalf tattle Title Company,Governmental Agency and Lending MAP OF AQ UAVI EVV PARK
1 Institutions listed hereon,and to the assignees of the Lending Institution or
subsequent owners I i
Copies of thus document.not bearing the professional's inked seal or embossed EAST MARION TOWN O F SOUTH O LD
OF �, seal shall not be considered a valid true copy.
��.�� L.
The offsets[or dimertsipns_]shown hereon from structures to the property lines are 1 SUFFOLK COUNTY NEW YORK
I fora specific purpose and use and therefore are not intended to guide the erection of ,
DESTIN D.Gi3�lF I fences,retaining walls,pools,patios,planting areas,addition to buildings,or any other I i
construction
.fair The existence of right ofways and/or easements of record,If any,not shown are SURVEY DATE: 4/19/99 —
a— "•;,=-1-.1 CC i _ not guaranteed I — — SCALE: — `
1 50
. ,_.Y? - CERTIFtED ONLY TO:
c�+ Qi
- cc ? WARREN P. WALKER t
N.ENSE 0'0506457co I DESTIN G. GRAF
�to
-
9p �P� LAND SURVEYOR
"-' --- - --' --- - -- - ---- -. -- - -
- 73 Woodlawn Road
( Rocky Point;New York,11778 i
j -- - -. - - I i 516-821-3442 1
I. ... . ... ..... ... ._ _ _ _ •----- -- ---____ �_-- - .- .__-- By DEST1N G_ GRAF N_Y^S. LIC NO. 50067 I i