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•40IFFOUretO'ELIZABETH A. NEVILLE � _V y'd Town Hall, 53095 Main Road
TOWN CLERK k ® - P.O. Box 1179
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Southold, New York 11971
REGISTRAR OF VITAL STATISTICSP
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER ,�y�Q! aig $'',,•,/ Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER ,#.• southoldtown.northfork.net
OFFICTTE OF TTFFH����EOOTOTTWgppNCLERK
T.SOUTHOLD WAGS AUtwATERUDISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. 2883 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : TARA O'SHEA
Address 1 : 11365 SOUND AVENUE
City St Zip MATTITUCK NY 11952
Descripton of Proposed Construction or Alteration
ADDITION TO EXISTING SYSTEM.
APPROVED AS SUBMITTED. MAINTAIN REQUIRED SETBACKS FROM ADJACENT
WELLS, BUILDINGS, PROPERTY LINES AND WATER BODIES.
EXCAVATION INSPECTION REQUIRED.
Name Of Owner O'SHEA, TARA
Mailing Address 1 11365 SOUND AVENUE
City St Zip MATTITUCK NY 11952
Property Address 1 11365 SOUND AVENUE
City St Zip MATTITUCK NY 11952
Tax Map No. section 141 .00 block 3 lot 6.002
Cross Street FACTORY AVENUE
Building Permit Number Cross Reference:
Issue Date: 9/24/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
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ELIZABETH A.NEVILLE t,,�7� la; Town Hall, 53095 Main Road
TOWN CLERK % o - % P.O. Box 1179
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REGISTRAR,OF VITAL STATISTICS � � PreI Southold, New York 11971
MARRIAGE OFFICER ,fiL l��1�, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER #4f t).
����i� Telephone (631) 765-1800
FREEDOM OF IN`•F'6 TION OFFICER���,�S" southoldtown.northfork.net
!. z \`' OFFICE OF THE TOWN CLERK
1}I i } SE.P 4 ® 2002 TOWN OF SOUTHOLD
.L: dL =i��� l_n
oT 1:'�� ` -) ' outhold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: September 10, 2002
Transmitted herewith is a copy of application No. 3006 for a Cesspool/Septic Tank
CONSTRUCTION/ALTERATION Permit submitted by:
Tare O'Shea
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: Maintain required setbacks from adjacent wells,buildings,property lines and water
Bodies. EXCAVATION INSPECTION REQUIRED. .
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Signature
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Dated
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OFFICE OF THE TOWN CLERIC $•�'C400LKc
TOWN OF SOUTHOLD "G. Q Application No.
Fr77ABETH A NEWLY F,TOWN CLERK � � ��` PP
P.O.BOX 1179 ,1 Construction
SOUTHOLD,NEW YORK 11971 Z i
Alteration i7
Telephone
‘04.,. �Q��` $10.00 - Residential
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(631) 765-1800 �1 �,,l $25.00 -Non-Residential
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TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. .
Fee .$
DATE 32-kjjCe- \Z-S2A. k O caarQ
t
APPLICANT NAME: -• Aci., 0' 4 0
APPLICANT ADDRESS: ga _! A. w.
‘1141:41_ k. b . r ' W 00 V �5o�
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SEPTIC CESSPOOL k
DE CRIPTION OF PRnPOSED CONSTRUCTION OR ALTE'ATION
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LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATIO :
OWNER OF PROPERTY: 3-A. 3-- 0
OWNER MAILING ADDRESS: ' '3( 3 � ,
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Icir,o, ,4____ kke_k.ti ittZKI kA.C78 -N
OWNER PROPERTY ADDRESS: \A Stgi, t i rc ,� c,,�LV Q,
kid '� rv. tip !itt,\\Qf e
TELEPHONE NUMBER OF CONTACT PERSON: 6_ 2")‘. B ► QL
TAX MAP NO. : Section 11-R Block 3 Lot j
CROSS STREET: (7).� cO(LO V
BUILDING PERMIT NUMBER CROS FERENCE:
' :::1:: 16t. it--70-77"---- r11141f0 . '
Si nature of App E1 W
RECEIVED BY: dy tin
Town Clerk's Office
DATE: 9��oIoi-'
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SDUND
SURVEY FOR •
NOTE a : MONUMENT SALVATORE J. SANSONE
DATE ocr. 23, 1979
AT MAT�rITUCK SCALE: / - '40II 1
TOWN OF SOUTMoLD Np T9 -6!l
SUFFOLK COUNTY , NEW YORK
*UNAUTHORIZED ALTERATION OR ADDITION TO THIS GU RANT TDsuRI TLE/NSURaNCECO
NEW YO IS A AYE VIOLATION OFIO SECTION 7209 OF THE PCE cit:
NES
NEW YORE STAfE EDUCATION LAW c34'1*.
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+F COPIES OF THIS SURVEY NOT BEARING THE LAND P4D W. Gtr
NOT
CONSIDERED TO BE A VALID STRUSEDE COPY HALL
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THEPE*GUARANTEES INDICATED HEREON SHALL RUN ONLY 4
THE PERSON FOR WHOM THE SURVEY PS PREPARED, 1 A 2
- AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN-' r � l
MENTAL AGENCY AND LENDING INSTITUTION LISTED
H AND 10 THE ASSIGNEES OF THE
TRANS TRANSFERABLE , � t
INSTITUTIONit
GUARANTEES ARE NOT Vrl/r /1 �, / ssssv����y+
TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
OWNERSN 'i A. 4589'
TO EXISTING TSTRUCTURESOARE R FORARSPECIFIC INES j
PURPOSE AND ARE NOT TO BE USED TO ESTABLISH �� � SUR�E�'
PROPERTY LINES OR FOR THE ERECTION OF FENCES
' 400 0S�(LRAN0ER AVENI,
YouNG YOUNG RIVERHEAp , NEW YORK
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ALDEa yy-YOlJNG,PRDFESSIDNAL ENGINEER f� �` I
SURVEYOR NY.S,LICENSE NO 1284 �12. n ?'
AND LAND SU f '-�' r ' J
i /Z '7 S HOWARD �'•YOUNG, LAND SURVEYOR
!'�R 2328 5 .
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11- __ ___ v_ '''. . - 'Av_a_i___IC NSF NO.4`5.893__
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