Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
TR-4481
, a� -: >. ,'�� iy ��ff,"�,,• ^• >.% ske; ..aye{ `.J k:Q'J� `� �`'y. �j� ji ik 1� Board Of Southold Town Trustees i► ; SOUTHOLD, NEW YORK 1es ;��. .:.t• 1 PERMIT NO. .......�..'7.. ...... DATE: .....614919.5.......... �I �. . ISSUED TO .......PAiJL...CACIOPPO �.. - Pursuant to the provisions of Chapter 61.5 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the k�I State of New York 1952; and the Southold Town Ordinance en- !` titled REGULATING AND THE PLACING OF OBSTRUCTIONS ih / i! IN AND ON TOWN WATERS AND PUBLIC LANDS and the !w� REMOVAL OF SAND GRAVEL OR OTHER MATERIALS FROM F J 'I LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on ..6/291:95....... `- 19.......9.5, and in consideration of the sum of $..1.5..0.,.00......... aid b -.. p y ... ._ ..........................................................•: }, .:.....Laxxy....Lzsco..£.ar...P.A.U.L.. CA.C.ZQP1?.Q.. of New Suff.Qlk N. Y. and subject to the ' 'i Terms and Conditions listed on the reverse side hereof, , a! of Southold Town Trustees authorizes and permits the following: e� Construct a one family dwelling with no disturbance to the lank��,y'� A.1 on the west side of house and the placement of haybales and snA fence be done during construction of house. all in accordance with the detailed specifications as presented in the originating application. if 11 4 4 l J V. r IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to ►;;,... �' a be subscribed by a majority of the said Board as of this date. o91 t FFO Q Cn �A .. ................ j j Trustees 40• Y ��.�.➢ «.:.t..Y� vS 1 F ! � 4 A� A'Y.Y:._✓T a%� �:Tt.,.+w�" �•:�.i�.r^R�+t 3pr :^.i�e:�1 5'yr��dWf�•4'+•�-sl••�� \ RRR}:a}yYYY�w�� aaa ' w�.s .�..�...�ua�+s�.�.u:...�AJl..�.i, _ '= �fSu—•.n; / ���,A, ,%'�� � s 7.i.�- ,A 'Y✓h�y'` � � y 5l!.�.R�i � � r/^ � a3y� .^ � l I OS�FFOL Albert J. Krupski,President �p�. OG Town Hall John Holzapfel, Vice President c y< 53095 Main Road William G. Albertson y Z P.O. Box 1179 Martin H. Garrell O Southold,New York 11971 Peter Wenzel y'l�pl �a0� Telephone (516)765-1892 9 Fax (516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 30, 1995, Lisco Construction Co. Larry Lisco P.O. Box 439 Jamesport NY 11947 Re: PAUL CACIOPPO SCTM #116-3-18.1 Dear Mr. Lisco, The following action was taken by the Board of Town Trustees during its regular meeting held on June 29, 1995 regarding the above matter: .WHEREAS, Larry Lisco, on behalf of PAUL CACIOPPO, applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated May 11, 1995, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on June 29, 1995, at which time all interested persons were given an opportunity to be heard,. and, WHEREAS, the Board members have personally viewed, and are familiar with the premises in question and the surrounding area,_ and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth. in Chapter 37-18 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approves the application of PAUL CACIOPPO to construct a single family dwelling with no disturbance to the land on the west side of house and the placement of haybales and snow fence be done during construction. Permit to construct project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. CAC z�q June 21, 1995 to construct 95' x 3' fixed_ dock; 15' x 3' ramp; 6' x 20' float. No dredging or filling. The CAC recommends approval of the project but not the scope of the plans. The length of the catwalk is an excessive intrusion. The Council recommends the catwalk be shortened, but, cannot determine the length because there are no accurate soundings. The CAC suggests the Bay Constable do soundings to determine a proper length. The CAC also recommend the width of the catwalk be held to 3' as shown on the plans. Also the Council suggests that a 10' non-turf buffer be installed. Indian Neck Road, Peconic Vote of Council: Ayes: All Motion carried. No. 1273 Moved by Bruce Loucka, seconded by John Hagerty, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH STIPULATIONS of the Wetland Application of BORIS CRZIC 50-2-19 to construct a one family dwelling, decks, .sanitary system, bluestone (or similar pervious) driveway, all landward of crest of bluff. Construct a series of platforms and 4' wide stairs above, at and below crest of bluff for pedestrian access to beach. The CAC recommends approval with the following stipulations: 1 . Keep all construction, including septic system, over 100' landward of the Coastal Erosion Hazard Line. (Stairs excluded) 2. Be sure the stairs end at the toe of the bluff. 3. Elevate stairs 3' above the slope of the bluff. Sound View Avenue, Southold Vote of Council: Ayes: All Motion carried. No. 1274 Moved by Stephen Angell, seconded by Allan Connell, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH STIPULATIONS of the Wetland Application of WILLIAM BEAL OR PAUL CACIOPPO 116-3-18 to build a single family dwelling. The CAC recommends approval with the stipulation that there be NO DISTURBANCE OF A 50' BUFFER FROM THE WETLAND LINE and that hay bales and silt fence be used landward of the buffer at the toe of the fill line during construction. New Suffolk Avenue, New Suffolk Vote of Council: Ayes: All Motion carried. No. 1275 Moved by Bruce Loucka, seconded by Allan Connell, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Application of MARTIN J. BANCROFT, JR. 27-2-2.3 to enlarge/enhance existing freshwater pond (only in width) to 300' x 240' from A♦ Albert J. Kru ski�President o� ea Town Hall P G John Holzapfel, Vice President �� y�c 53095 Main Road William G. Albertson y x P.O. Box 1179 Martin H. Garrell O Southold, New York 11971 Peter Wenczel y'jlpl �a0� Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD S.E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000-116-3-18 . 1 Chapt. 97 - Wetlands NAME: Paul Cacioppo Chapt. 37 - Coastal Erosion DATE: May 26, 1995 RESOLVED that pursuant to Article 8 of the Environmental Conservation Law, State Environmental Quality Review and 6NYCRR Part 617, Section 617 . 10 and Chapter 44 of the Code of the Town of Southold, notice is hereby given that the Southold Town Trustees, as Lead Agency for the action described below, has determined that the project will not have a significant effect on the environment. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an application pending for the same or similar project. TYPE OF ACTION: Type I DESCRIPTION OF ACTION: Applicant requests a Wetland Permit to construct a single family dwelling as per revised map dated May 15, 1995 . LOCATION: SCTM #1000-116-3-18 . 1 REASONS SUPPORTING THIS DETERMINATION: 1. An on site inspection has been conducted by the Board of Trustees . 2 . An environmental assessment, submitted by the applicant and reviewed and completed by the Board of Trustees, has indicated that no significant adverse effects to the environment are likely to occur should the project be implemented as planned. cc . CAC .,,.,...,..�..e.,,....•�,,.`.�„•.,.,....,�..o.���w..—..........,.........,�.........�..�.....—., w....�....-.�.------ .. .r--+--:T•.y.r—r�ia_•:�r.�caax-�;-!.ti i� .. �., $Jew York State Department bf ironmental Conservation- •Building 40—SUNY, Stony Brook,'New Tvck 11790-2356 4L%" -':_• ( 516 ) 751-1389 ,fir..•{'•r::. 1r FAX ( 516) 751-3839 �•U. ��1C Thomas C..lortin9' . .. . AMENDMENT TO PERMIT Commlaalonor ! ! Former- Permit # ( if any) : Owner : % RE: Permit No. & Location: ` U�l ���Z �/_ (7/ j ;;�• • i Dear I1�`iour recent request to extend the above permit has been reviewed pursuant to NYCRR Part 621 . The ex iration date is p ,:. extended to l/ 3 U Your rec request to modify the abov __-permit has been reviewed pursuant YCRR, Part 621 . as been determined that the proposed modify s wi not substantially change the scope of the permitted actions existing permit conditions . . Therefore, the permit i ' amended to authorize AV This letter is an,-amendment to the original permit and as such, shall be posted at the job site `•:�; f��' All other terms and conditions remain as written in the original permit. Ver} truly yours, Deputy Regional Permit Administrator :;,;k�• cc •Yi.'� 'A.1 1 a[[ 7CC,. VATCN LIYE _aEE IEC.z NO_10P _ _ YATCN -_UN[ } TP,10 FORr{RccL ro. .03 6o• I -a- TORN Or CIO r IYII•t•Y•r•• es) .. A• 'S.a Me PASCAL So SEE'fG ND 09.04.Ta AA 43AM 3 al�iUl � O � •I l awlcl } iiutu T O TOWN OFas t•1 � LWeI �. . 74Nlat fOYTNOLD T � It••l•1 7 104A• _ I 11 2.84a1 Z Yr ` .i •a 10 O ` 3.641•1 1 '� It 4. 1 as ll a2R1 a l LOA nU 1• es.: 1 - r 2.2041.1 i II.RaI.1 f IY 1i a AI O I.7A 11e1 �:. `\ �L Y d CASE RD. 1{aal a♦ it IA a fra ° r 1 lu. R _ , tl•1 Aft Q as f \ R,•al•1 All J , t { g 7 A is <A.M}•1 \ __ •, •IT Qncswro d a NEw R DIa7RIDMTNI N •+ a t AVE. la � � L21e11 ¢ raRCT.i y ,•• .. .• i•-p\.•! - 7' I. I / ' L 1� 1•a ' ,f -.© 41 aAtMl IM . t N ;� IA{k) • •t. uit)r m' I I uilal :e,w�..y bt L7Ne)'"- alull•1 a• ��.. uM.1 .uqA LII y LW L I.A. e.41N li r n.1 IA1 'IA T.•{DI 1:a1e1 O wc+ 1..1.' a ••.oe^• care _ •. .• I4 ,.• �kq•,. ,. 1ANe1 aial. + u.r 11;. 'b 2O s• '\.._�_�_"•.7ayj.... :_ ILI ro�s6url�c C!O) L LWeI I Ivton••m L��k1 9� t i; s+o•eLr—��L•-_ / Lwttu.=.w. To".(L•LL.z luial J1Jrofa c • �,1;,a 4+W Liikl; t roLiN ar P£CON/C -k w .., 1.fi1a1 ' `SOYTMQD � L .�"�t 1a`• �'• 1. La� +•+• o'�� ?,q 6.1mLI �1 `^ ^� •^ ' F.D.29 r'do• T4 11 SEE SEC.NO Ia• y� \ o•O AO a.Aw a.a CAW a t a+ + + •lytf s° ° •_ GREAT C. �`" .enr•o .•..r••_ , jib -r �8•�� N_ Pp11 f0 uiLL. •....faf.L•.n�,ul i�mn��u w Lonct /•��, r '•7 d Y w `�49/ 6: s .L•Du Tf iedl.__f•�.eaf.Y_._° w:a'w 4u••w'�n',.°'D,>.•'if �'t�/�7 ` �I OTC .�J_b-.� LL,eL �4 AO.�Ii•.t��wiSL Kai° LeQOed KETRAP - © .COUNTY OF SUFFOLK Ta+"Q SOUTHOLD 'iC7°"M0• r•'•�i1•' P,w..,f,.RT IM C.rY LY. r1w D, LIy _�.P._. Ilfiw,G.•w L•r�_.N•--- LLLm1w Lr N.. Dn 116 RIEI91L 51111,81. D,y.•Cw..D... T—Lr ...,D—L" __ _ '•' 'F°-- ° - '°° '• Real Property Tax Service Agency 011TRI T'N M.TJ.[.llllj �— - R,4w P,oMllw__-A•-- Pa Dw•Nn {T .�n L_,d,.•Tfyw..r f+/Mar LM L•. __��_ T.lylr —�� LI/•Di,wlLr ��.L•�- •Iwt 1b O7 M,W W.,••w• •T, •f fCI1l lM refl COYOIr t.RNI•f DISTRICT IAI. �000 �,,.=.._ _ •s.N. n P.Ir.. 1r•ta _ RiverbROd,L.I.,Now York ya_ry(yy Pl4P_F.RL1L•f1' Albert J. Krul)ski, President Town man John HolzalAcl, Vice President 53095 Main Road CC William G. AlbertsonCC P.O. Box 1179 Southold, New York 11971 Martin Ff. Garrell Peter Wenczel '70 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Oi a N Q9 Coastal Erosion Permit ApPlicat A T—Wetland Permit Application MAY 1 1 1995 Grandfather Permit Application Trustee Lands Permit Application Waiver I Received Applicatianvi-ht/7'r- ITOWN OF SOUTHOLD Clerical Review: —Completed Application Incomplete / �� SEQRAClassification: Type I Type II Unlisted _)C Coordination: (date s n t) 9 A CAC Referral Sent . Date of Inspection Receipt of CAC Repo e Lead Agency Determination: i Technical Review: (da e) .,X Public Hearing: (date) 4 9 - W I Decision: Approved (Y/11) (date) Application Fee: 0-0. ZVI Name of Applicant ARAM4, -CA C to -PPP) Address !JY.-(A)' ,1L7b.Aj Ab seiatA)c aAP- Phone Number: (-5/G) T Suf folk County Tax Map Number: 1000 - -Sc--Zi j3)- I F. Property Location: EvL k 4 3 (provide LILCO Pole distance to cross streets, and location) r Agent: 44"y LIS6 cy 0 A&I. ( If applicable) Address: .0.0. '60 tA"lc 4 Phone: Bo l of 'Trustees Application GENERAL DATA Land Area (in square feet) :_�'7, 3'7/ Area Zoning: Previous use of property: L t%.N D Intended use. of property: v ONE {-a e-+ �L.�! �+-��'-►-�-�tJ G Prior permits/approvals for site improvements: Agency ate 13, No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ✓No Yes If yes, provide explanation: Project Description (use attachments if necessary) : 15t. � L� dtil L�� VV- GI..LI � L - �i R y�- 2 Boz of Trustees Application V WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot:— v N E square feet Percent coverage of lot: o Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: fS' feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? ,.47o o cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations:?SR SvA _� — ,. Manner in which material will be removed or deposited: vL�L D v E 0, Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason os such proposed operations (use attachments if appropriate) : 6 14-16-4(2187)—Text 12 PROJECT I.D. NUMBER 617.21 SEQF, Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1..APPLICANT/SPONSOR 2. PROJECT NAME I; ra- 4-ioPPb 3. PROJECT LOCATION: Municipality Cz w S aJ k' C'o L l= County .5 L' 4. PRECISE LOCATION(Street address and road Intersections,prominent landmarks,etc.,or provide map) jy/s - N E w S i r FvLIW 1*-E — aoS� 3� ` � �r1;1-4wo,-at, Rom. 5. IS PROPqSED ACTION: New ❑Expansion ❑Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: _ 7. AMOUNT OF LAND AFFECTED: Initially / .SP acres Ultimately 7 3 7/ 5 acres 8. VVILL_PRQPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Yes ❑No If No,describe briefly 9. V4HATJ&PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other - Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)? Ea Yes ❑No It yes,list agency(s)and permitlapprovals 11. DOp ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ❑No • II yes, list agency name and permitlapproval !i 12. AS A RESULT OF�OSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Pr (a- ` t S O _L l S o v,� c o Q Date: Signature: " " If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this a. sessment OVER Bo, _ .[ of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPO ES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE 'OF SAID PERMIT(S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS /D 1 DAY OF �� ,19� Notary Public I)OLORES L. LISO Notary Public,State of New York Suffolk County-No:48M0220� Commission Expires Oct.31, 3 . Bi d of Trustees Application AUTHORIZATION (where the applicant is not the owner) I / f�l/G /'/��.���/'r� 1 _ �ee residing at�T �/L�0 ,,45. LO� 5�• �'B� /�y {print owner of property mailing address) do hereby authorize (Agent) 1IS6'2 to apply for permit( s) from the Southold Board of Town Trustees on my behalf . (Owner' s sign e) 4 SUFFOLK CO. HEALTH DEPT. APPROVAL JUN TOWN F SOUTHOLD ---', • ,-,; ,,iJt;1 h ,�1,iL ice,; r-, t.�-', / �. • : k 'STATEMENT:OF INTENT i THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE' WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES: i c�' u L1; APPLIC V ANT i ,ty _, :; ; •': a, r .` �.-'•;•.�, ; - SUFFOLK COUNTY DEPT. OF HEALTH S.ERV"ICES — FOR APPROVAL FOR _1-— i• i' --- - _ - 1 CONSTRUCTION ONLY ?� i b e, h� - f:..• I,ry __ _ ..��- 1 `'° DgTE: •*� H. S. REF. NO. ,, ti ;j , t 1,', APPROVED: 4 :1 1• M -- - � 1, , } �1` - -.s ..�.,-_ .. SUFFOLK CO. TAX MAP DESIGNATION: .t ;, ht 'yt`''' t/ ��t ; t- 1 ! +. ~to �_- '4- •F r; '., ' r .' �. r._• SECT. BLOCK PCL. D I ST. J '1�., ; . -. - l'is .�' t, tit .�� - � �t�f�i!_'•j ! 4r }- ` l+ r '? if `••? I S; t,` ; �' �4 '+ 14, " "I _... . :t ' �'=_ >r :'t7 1jj(r. .,' 1�.t A.� : C7_ I OWNERS•.ADDRESS: Al . � 1,) _-d .`I' `1 ;. � ' �Ct :� Q, t to ' � '. - L.r..1'(:! ���Fl ?•`:L,' f,i!�`,t r_.5,_. S. .. _ .0 1• !' � �t �`.r� � r, ,:.•'w: �. r y\ r S' -" ', n � ,r-'a 9, .. I ^i• ''� :i , ter`, ,� t yl 4j' '-' '`'+' tt, ''` 1 `� ,• '_:y.. `y; `' *�I Pi •1 � gtir 1•'. 1` d .. r',. 1' Gi w �•,` 1 �,,, ,r.• rr 7... Y.0 - - i ` '', �` ;�+a�:q' , :_ ' ' �' DEED: L. l e ? P.. . - �. NO t •^ r :L 'r; TEST HOLE STAMP Unauthorized alteration or addition to this survey is a violation of r -- - ' Section 7208 of the New York State Gdccafion Law. . 7 7 • •K � .. `�: j',c.r • l _____..,h-._..__.....___._..,._...._._1____._.-_- _ __,.-.. �� .__... -- -- - '' _ Cc;•';of this survey map not bearing , - . . �!-�..�__�______,_:.._.�...,_._�_.---_ ,r c' � ..� .�•'.� i'i?'"`.•`�" th_`any surveyor's inked seal or �Vt• f•L7,e��.:: ,�i L�"U`f. `� iE�i 'C?,Y��� -j w: .d..�).�...t / .., - -- --- a f cmlccsad seal shall not be considered •. to be a vc.3d true copy. . • / , Guarzntccs indicated hereon shall run _ ,_�• I -y,x - r,_,r' /;- e ! �, only to the person for whom the survey r r. o, ;?,� %":r t 6 s:'%, 'a r !? r �a'• / is prepared, and on his behalf to the I tide company,governmental agency and lending institution listed hereon and. e,-b„rrl-Gr to the assignees of the lending Instt- lution.Guarantees are not transferable -__ to additi nal institutions nt e orsubseque -- r' owners. i r M<,, SEAL OF C� 0O� 9!L.A f-7 ry RODERICK VAN TUYL, P.C. (� o e sFo 4 S 2 5626 LICENSED LAND SURVEYORS '=' 4AND 50 di'rf'" t?[;; ? 1 � GREENPORT NEW YORK• 'TELEDYNE POST N91329 SUFFOLK CO. HEALTH DEPT. APPROVAL =JUN - I_ F SOUTH OLD �Dt• 1r9 _ tYf� �� �' STATEMENT OF INTENT rj _ . _ .__._ j - I THE WATER SUPPLY AND SEWAGE DISPOSAL SYSTEMS FOR THIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE <' 4Fi fI ! r rY r P�yf - - t � � . ! SUFFOLK CO DEPT, OF HEALTH SERVICES. ' APPLICANT �►3 ` 8S "•_ SUFFOLK COUNTY DEPT. OF HEALTH -- -- --' �"' SER V ICES - FOR APPROVAL FOR CONSTRUCTION ONLY D A TE. r• u L �l 'P�Ie _�.-rt'ie:k: H. S. REF. NO APPROVED: SUFFOLK CO. TAX MAP DESIGNATION: C4�. /-- . GIST. SECT. BLOCK PCL. I {� '� ' b ,n•' +, "C:' + ` •fPl�fctltCs"t.3 t"4" a'Y f'4 lT1�frJt7 �#� l�vf?%Nf3 © OWNERS ADDRESS: iVj tCl t7 ,eC?�Jxt j�* r1'." qat'd��tr; 7} 367 4,06 �t r i a . � .. Cy DEED: L. P TEST HOLE STAMP 1► L Unauthorized alteration or addition r ,' 9 `y are ff y' � to this survey i,a violation of 1 Section 7203 of the New York State / I. L� f G .+on Law. r7. �► y�E� a, 7 p �,/ �y � � cc .c t -s survey mao not bearing ��F•d 0.. Z Q✓ .� J/ ,�/.Q _ _ !f1 d - e -._... r real inked seal or u ✓. _ oai shall not be considered G�'�f�flLl��t7f tobea: .. true copy. 'ne :r Guareric:.s indicated hereon shall run �r ♦t� • 1 only to the person for whom the survey �, , „ t;' f;• f� t 1�r 4 t,. f . j;.5 - --- -. - '7.1 N is rrapared,and on s behalf to the r` Iva�, t15 i ' . } y^. the;;ompany go:e•rmental agency and i 'Y _ Curd 1''t, lending institution lis;ad hereon and to the assignees of the lending insti- tution.Guarantees are not transferable to additional institutions or subsequent owners. SEAL ti: p I c ne,Kd �E O F NFL CO'`Q�P�CK V,92 L- IS, 199S t- i RODERICK VAN TUYL. P.C. c�Z,�orr e mac•.^ T�.� yl� sr '<S?5E26 A LICENSED LAND SURVEYORS � /•" O�gND '`IP�F 'bt/m`' 1404j6e GREENPORT NEW YORK TELEDYNE"T .u913I9