HomeMy WebLinkAboutWexler •i"c FFO`'c
ELIZABETH A. NEVILLE '4,h`' 1 Town Hall, 53095 Main Road
TOWN CLERK ® = P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ‘It Southold, New York 11971
MARRIAGE OFFICER `-44/ ``011/, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER "'/®1 $ �i0 Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �:,so.
southoldtown.northfork.net
OFFICE OFATHE TOWN CLERK
SOUTHOLD WASTEWATER DISPOSAL PERMIT
CONSTRUCTION OR ALTERATION PERMIT
SEPTIC, TANK or CESSPOOL
Permit No. 2933 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : HOWARD WEXLER
Address 1 : PO BOX 1056
City St Zip REMSENBURG NY 11960
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 #R10-02-0187
Name Of Owner WEXLER, HOWARD
Mailing Address 1 PO BOX 1056
City St Zip REMSENBURG NY 11960
Property Address 1 470 LAUREL COURT
City St Zip LAUREL NY 11948
Tax Map No. section 125.00 block 4 lot 24.011
Cross Street LAUREL WAY
Building Permit Number Cross Reference:
Issue Date: 10/30/02 Elizabeth A. Neville
Southold Town Clerk
(TOWN SEAL)
4
ill 0004 -_ Os'? 3 3
ELIZABETH A.NEVILLE �_e y�\ Town Hall, 53095 Main Road
TOWN CLERK H P.O. Box 1179
REGISTRAR OF VITAL STATISTICS i Southold, New York 11971
MARRIAGE OFFICER `�,li ���, Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER � Ql 4. '04.*o. Telephone (631) 765-1800
FREEDOM(*INFORMATION OFFICER southoldtown.northfork.net
'bve . OFFICE OF THE TOWN CLERK
(
,, 2- TOWN OF SOUTHOLD
O Southold Town Building Department
FROM:.r Linda J. Cooper, Southold Town Clerk's Office
DATED:
Transmitted herewith is a copy of application No. 3054 for a Cesspool/Septic Tank Construction
Permit submitted by:
Howard R. Wexler M.D.
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: yr-
/'
27,4„‘".#?‘,/
Signature
Dated
t d
1
c w)
6'' r
OFFICE OF THE TOWN CLERK sill IcAnj/n,
TOWN OF SOUTHOLD 'e c\ QG�'; Application No. 3 o5
ELIZABETH A.NEVILLE,TOWN CLERK i
P.O.BOX 1179 • Z Construction �—
SOUTHOLD,NEW YORK 11971 : =• v •cnL3/4.711 • Alteration c/
Telephone �,y,�, lid ���' $10.00 -Residential
(631) 765-1800 = �l
$25.00 -Non-Residential
.-----, ....,,,,#0 1/
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No.
Fee '$
DATE /D -02. --a,o62
APPLICANT NAME: / prig-,Q,0 R. W xz.e-R? h'I. b,
APPLICANT ADDRESS: Po BMX /65-6,
REmsE/via,R , ,u.3„. If %O
SEPTIC k CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION
N2w #001 -c,
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: #00 9/9fe.,A R, ode x 6672, yn,/),
OWNER MAILING ADDRESS: Pp/3o /® S 6
ik_ 14 SEAL oR.G. 1 /4K /t q6o
OWNER PROPERTY ADDRESS: /- 70 k.i LLi2.CL Noc..uzV
1 L 00-4-7L j Al V //t ste
TELEPHONE NUMBER OF CONTACT PERSON: C6 /) F3 ?-- 7.600
TAX MAP NO. : Section /02S- Block O424 Lot All, If
CROSS STREET: i(, ,QE'L (-34-y
BUILDING PERMIT NUMBER CROSS REFERENCE:
:,�. _.fit'
� '�' 4
Signatur-• of Applicant .
si.
RECEIVED BY: Lb -d
o n Clerk's Office
DATE: 6 d Ia-$�16. _
V-1
' tor 0 ._._... .._.. --_ .._..
I SUFFOLK COUNTY DEPARTMENT(}>.FIRALTH SERVICES 1
f
VACANT , I
C/3/9 e/32 S 20 2O• PL"EiFtT:'9 FO APPROVAL OF C:�F S Lff 3 i:1.FO A •
�b 50'E. �IGL^3T WILY IlL:SIII)EPtC'OtU.S
)11\4.
S" ��l a �01 ,g r;i1 .)-F10�,0a� r1
DA /
iia 9z APPROVED �.�.`...�... I
J t '
1. 017' c'e N Jo is •' FOR MAXIMILV!OF UED1.00+`0 ;
CY r0` • " • art EXPIRES THitEE YEARS FROM DATE OF APPROVAL <
At V .� v -��
co 0 ct` 6/a9 enve/o./oe
0
P •
.k �Ah e l am familiar wl/h the STANDARDS FOR APPROVAL
.o - AND CONSTRUCTION OF SUBSURFACE SEWAGE
G,/ \i" c m� ab. S X p s>,/ o� DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
v7 and will abide by the conditions set forth therein.and_on the
J�. `` 6 permit to consirucl.
y
p�� a9099\"r w Q to �\nl 0
�'
�� • . �p Q� o k\t o "0 4Z SURVEY OF PROPERTY
Px.30 k �o'� AT MA TTITUCK
TOWN OF SOUTHOLD, N Y.
ys ' 3 SUFFOLK COUNTY,
0d 2s,
.39. 6o ; . N. Y•
6• ` 1000 - 125 - 04 - 24.11
i. SCALE: 1" = 30'
<.e, oa 4;,- SEPT. 25, 2002
-�• a hh•
I, . /
gat
kL
P� DA 4.,
o
70 7
aes--
P
/� 0 �tOE °EII'
Oo/. P 0 cz �N t.MfT4.i��
h The locations of wells and cesspools o
"sr ''
OP h� shown hereon are from field observalk 1 ``-` '"•`C
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION r , A'r.;; C.
OF SECTION 7209 OF HE NEW YORK STATE EDUCATION LAW. �"` e ' '�+',: