HomeMy WebLinkAboutJadow ELIZABETH A.NEVILLE,MMC , �� fl Town Hall,53095 Main Road
TOWN CLERK 9r P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS y' Fax(631)765-6145
�� ��°gym"i0p p�) Telephone(631)765-1800
MARRIAGE OFFICER °
RECORDS MANAGEMENT OFFICER � ��
�µ www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER , .
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Southold Town Clerk's Office
DATED: February 12, 2021
RE: Cesspool Construction/Alteration Application
Transmitted herewith is a copy of application No. 4942 for a Cesspool/Septic Tank Construction
Permit submitted by:
Eric Jadoa
Please review the application and location map and advise if this office may issue the permit.
Please complete the form below and return it to me. Thank you.
I have reviewed the application and location map of the project cited above and make the following
recommendations:
APPROVE
DISAPPROVE
Comments; .
Signature
Dated
Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 02/12/21 Receipt#: 277936
Quantity Transactions Reference Subtotal
r 00
.... ....._ ...�. ....._ ....._. ... 4.942 10..
WW mT 1 � Septic Permit-Constuct- Resid
Total Paid: $10.00
Notes:
Payment Type Amount Paid By
CK#449 $10.00 Jadow, Eric A.
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Jadow, Eric A.
3655 Stillwater Ave
Cutchogue, NY 11935
Clerk ID: JENNIFER Internal ID:4942
ELIZABETH A.NEVILLE �� �� Town Hall, 53095 Main Road
P.O. Box 1179
TOWN CLERK Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICS w �
�� Fax(631) 765-6145
MARRIAGE OFFICER �^
RECORDS MANAGEMENT OFFICER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER �" southoldtown.northfork.net
ti
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 or Non-Residential @$25 Application No. qqq�2
Permit No.
Applicant Name _ ..
EIR
Applicant Mallin Adclres ,._..m
Mailing
Septic Tank mor C spool
Brief Description of Proposed Construction or
Location of Proposed Construction/Alteration:
Owner of Property., � .. � _
�. .
Owner Mailing Address ... _
mow.
Owner Property Address:—.....n '„ _�~ .__.....� __ .. m�.
Name andhone numb e... ..... .m.
p er of contact person
Tax Map No: Section ... .. ....m. .n.m.... .. Block ..... fit.. m. =__, .
Cross Street13
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY 1TH HEALTH DEPARTMENT APPROVAL
w
SJ I me of Applicant � ° Date
Received by
SURVEY O F: _. SUFFOLK CGIAl'P(I)EPARI ME'l mr of i MALT A
PROPERTY LOCATED AT CUTCHOGUE '"" ��
LOT No. 21, 22 & 23 AS SHOWN ON 2 ,`' �' " "
MAP OF PROPERTY OF M.S. HAND Date"
FILED: SEPTEMNBER 18. 1930: FILE No. 730
TOWN OF SOUTHOLD '
SUFFOLK COUNTY, NEW YORK
AREA = 50.370.2 SF.
S.C.T.M. # 1000-136-2-11
SCALE: 1"=40' r,a. Knepp r°w m'P.E , 'Vie
NOTE: THE EXISTENCE OF RIGHT OF WAYS,
WETLANDS AND/OR EASEMENTS OF RECORD ;
IF ANY, NOT SHOWN ARE NOT GUARANTEED.
ELEVATIONS REFER TO 1988 NAVD I�IPNplrl-
ELEVATION SHOWN THUS 4t
NOTE: WATER SERVICE AND SEPTIC SYSTEM LOCATION
BY OTHERS. B.O.H. REF. No,
SEPTIC LOCATION ` ]
'A` "B'
S.T. 30' 1 43'
L.P.1 78' 69`
FEMA: ,
TOWN OF SOUTHOLD No. 360813 62
MAP No. 36103CO163H
APOLE
MON. /
CS LPI
2
POLE ���,,✓.�C«'...
EXISTING COVERAGE = 1815.1 SF. = 0.4% 0
PROPOSED COVERAGE = 2617.2 SF. = 0.5%
01 0,
OA y ,
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION "` ,.
OF SECTION 7299 OF THE NEW YORK STATE EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED ti'j.p "I titi0
OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.
GUARANTEES OR CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO
THE PERSON FOR WHOM THE SURVEY IS PREPARED.AND ON HIS BEHALF TO y
THE TITLE COMPANY.GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON.AND TO THE ASSIGNEES OF THE LENDING INSTITUTION.
GUARANTEES OR CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL
INSTITUTIONS OR SUBSEQUENT OWNERS. `� CONC. �.
CERTIFIED TO: MON.
EJ INVESTMENT HOLDINGS. LLC
33655 STILLWATER AVENUE
CUTCHOGUE NY H935
2750-P2-A