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ELIZABETH A.NEVILLE % ; Town Hall, 53095 Main Road
TOWN CLERK o P.O. Box 1179
CA r� Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ® 4 0 Fax(631) 765-6145
MARRIAGE OFFICER Si �. �1
RECORDS MANAGEMENT OFFICER � �®1 . �i� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER _ rrrrr 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. 2850 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : GOLD CREEK BUILDING CO CORP
Address 1 : 77 STEPHANI AVENUE
City St Zip EAST PATCHOGUE NY 11772
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 #R10-02-0108
Name Of Owner EDSON, LOU
Mailing Address 1 MAIN STREET
City St Zip CUTCHOGUE NY 11935
•
Property Address 1 800 DEPOT LANE
City St Zip CUTCHOGUE NY 11935
Tax Map No. section 102.00 block 2 lot 6.002
Cross Street ROUTE 25
Building Permit Number Cross Reference:
Issue Date: 7/23/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
00
ELIZABETH A. NEVILLE ��� G��; Town Hall, 53095 Main Road
TOWN CLERK ® - P.O. Box 1179
REGISTRAR OF VITAL STATISTICS t Southold, New York 11971
�`,,�1 Fax (631) 765-6145
MARRIAGE OFFICER oz
RECORDS MANAGEME _OFFICAR � R/ ass -0,0 0 Telephone (631) 765-1800
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FREEOM-O NF g{OO 1g�ER southoldtown.northfork.net
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JUL t ® 2002 L-d OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
BLDG
1-0.01,Y •.3i SE 4t �ti,Ol D
TO Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: July 10, 2002
Transmitted herewith is a copy of application No. _ 2955 for a Cesspool/Septic Tank Construction
Permit submitted by:
Gold Creek Building Company Corp.
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: ,‘17*':?"7,9,fe•f--erm.,/t.ereee.c. ere-
.74(```'-‘1147
Signature
®7/4/0/4-
Dated
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/OFFICE OF THE TOWN CLERK ' '�l O�L �' -�
TOWN OF SOUTHOLD ��'elfO� \ �t CQ�y Application Nod ( S
ELIZABETH A NEVILLE,TOWN CLERK 0
P.O.BOX 1179 Z L •• Construction ✓
SOUTHOLD,NEW YORK 11971 o rn
Alteration
Telephone �j- Q��'�,, $10.00 -Residential ✓
toi ,'.
(516) 765-1801 '- - ',,,' $25.00 -Non-Residential
�,.,,,,
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCT ION or ALTERAT ION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee $
DATE ,' ..TOC' 'lot,
APPLICANT NAME: 6003 er t tzhoa co . CO2 R
APPLICANT ADDRESS: 77ST 'P/M-ri.91
E Pin -e , AJ y //77r/
SEPTIC CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
/Vec,v 14003-2
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: Zoo P.PS07\ -
OWNER MAILING ADDRESS: ,1/r-lA)5
Co rd!cUe 1 Y
OWNER PROPERTY ADDRESS: Od ? 1 ,44A)
CO'clioc --e / it/ `(
TELEPHONE NUMBER OF CONTACT PERSON: Dd/tagU g'4
TAX MAP NO. : Section /0a5-e-Block QQ cY. Lot a,,
CROSS STREET: P7-
BUILDING
jBUILDING PERMIT NUMBER CROSS REFERENCE:
' 1g u re of Applicant
� W D
RECEIVED BY:
Town Clerk's Office
DATE: li� (l]�
` ,;>�y .
. . _ .,..w...me.I S�rM„avvatsWe.,.. ..a,��..
SIIFFOL I:oui.' ,',:.0-'itl f,..:.,:ler f)i” ,'1:1,1,r.:I `3 ;: YJIf:`S !` ' '
LISA McQUILKIN PERMIT FOR APPROVAL OF CONSTRUCTION FORA 1. i,dom '
LAND SURVEYING BINDLE FAMIL`y RESIDENCE. ONLY
102 MAIN_ STREET /9
WEST SAYVItLE, NEW YORK 11796
. PHONE: 631-563-4952 Q� DATE'�IJJJ1.ST p .U/71 g_
AP ROVED �_ 1
I I�ti
FOR MAXIMUM OP T DRO®I,9.r,. ,/
I EXPIRES THREE YEARS FROM DATE OFF APPROVAL
ri
• x.I4, �� � 1
r, i,..y LOT t
♦y fl'i!.C'f), I (VACANT)
�'��,�� `�::; r '� N 510 00' 30" E 460.26
i I S�IG. 1 ��s ? ��s
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❑ S� PROP
A WELL Ch Z❑
V) t pi Io �� Men t° »pu
n O"I d 60' Min. .. ��m C
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" 'rI t c� I -t1�� N�„ 'n
SURVEY OF 3 "m y c I 60' MIN — +1 D• �7
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LOT 1 N� " '^ N '' �p N tz
MAP OF 7 a o I ro& '� GAR �,
..DEBORAH EDSON
I _J r� �+ 0+ D
• FILE N' 8539 a �7 I PROPOSED
so' m
AT GUTGNOGUE O I ` A
TOWN, OF SOIJTHOLD, z b 2 m o
'STATE OF NEW YORK c� I o
coo t�o I F z
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TEST HOLE \ im
AS PER FILE MAP ' S 5f� 00, 3U" W m 462.30'
0' m ro -Ii
TOP SOIL ut
I' I LOT 3 rr rn
4'o„ rri
`� �, A (VACANT)
LOAM I b
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4, r.
SAND &
GRAVEL
MAIN GOAD
20 UNAUTHORIZED ALTERATION OR
ADDITION TO THIS SURVEY IS A TO EXISTING STRUCTURES ARE FOR A SPECIFIC
I_ `2."•' '•?-'.1 1 VIOLATION OF SECTION 7209 OF THE PURPOSE AND ARE NOT TO BE USED TO ESTABLISH
-,f!v?7'rJi1 NEW YORK STATE EDUCATION LAW PROPERTY LINES OR FOR ERECTION OF FENCES
,1/4::j3;r`<<1-'_ �'�i t''2'} :_ `�.; ' CERTIFIED TO:
`' LIBER-TY SAVINGS BANK
S.0 T M. # 1000 - 0102 00, -7 32 Ops-P/0 06 200 MKM ABSTRACT SERVICES COPIES OF THIS SURVEY MAP NOT BEARING CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY
16 •1 ; , L- -,;ti "r}= THE LAND SURVEYORS INKED SEAL OR IS PREPARED AND ON HIS BEHALF TO THE COMPANY, GOVERNMENTAL AGENCY. AND LENDING
,.“.0,1t, FIRST AMERICAN TITLE INSURANCE CO. EMBOSSED SEAL SHALL NOT BE CONSIDERED INSTITUTION LISTED HEREON AND TO THE ASSIGNEES OF THE LENDING INSTITUTION
DATE: 5-24-024 _P _ir T� GOLD `CREEK BUILDING CO. CORP. TO BE A TRUE VALID COPY CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS
_REVISED: FILE NU-103804(12 ':i. 5CA E:1"= 50'
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