HomeMy WebLinkAboutBaner, John ELIZABETH A. NEVILLE
TOWN CLERK
REGISTP,..-LR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS 13.£ANAGEMENT OFFICER
FREEDOM OF INFOR~,K&T[ON OFFICER
Town Hall. 53095 Main Road
P.O. Box 1179
Southotd, New York 11971
Fax ,63D 765-6145
Telephone ( 631) 765-1800
sout holdtown.nort h fork.net
JAN
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO:
DATED: January 5, 2004
Transmit[ed herewith is a cop), of application No.
Pem~it submitted by:
John Barter
-S~ui~;'id TowR Building Department
Linda J. Cq.opej', Southold Town Clerk's Office
3417 for a Cesspool/Septic Tank Construction
Please review the application and location map and advise if the project has received Suflblk County
Health Departlnent approval and if this office may issue the pemfit.
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:
Signature
Dated
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTtC~S
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765:6145
Telephone (631) 765-1800
sour holdt own.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PER3$IT
CESSPOOL or SEPTIC TANK
/
Residential ~ $10d or Non-Residential C~ $25 __
Applicant Name '--) "' ~-", * "~ gvx, :,-~ ~&-e tf
Applicant Mailing Address [ ~ c-r av~ L_ o ~
Septic Tank or Cesspool
Brief Description of Proposed Construction or Alteration
Application No3~, I7
Permit No.
Location of Proposed Construction/Alteration:
OwnerofProperty: ~),:,¼r~ .- ~'e~'~5'=
Owner Mailing Address: [ ~'X3~,.e.~. Lo~--o---
OwnerPropertyAddress: ~ ~-l~ S~O ~'~r ~-e
Name and phone number of contact person ,75 o It,,, ,. 'c:,eai
Tax Map No: Section I ~o 00 Block G ~ Lot
Cross Street AIc~q J'c~ /~3t, ¢- 6r-~e'e~cc, o.~r'
NOTE: LOCATION MAP MUST BE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH ItEALTIt DEPARTMENT APPROVAL
Received by:
/
/
Lot 23
SubdiVision -
"Mop of Green /~creS At Orient"
Lot 24
SubdiVision - "
"Mop of Green Acres At Orient
(Dwelling)
-4
Young & Young, Land Survey'or'.
63
d[de~ W. You'll, P.E. ,~ L.S. (1908-1994)
Howard ~ Yo'u,'n,g, L~'r~ $~tov
Thowu~.s C. ~'od~pe'r~ Profess'~Aa~ E~e~r
HEALTH DEPARTMENT USE
SUFFOLK COUNTV DEPARllI£NT OF' HEALTH $£~
PERMIT FOR APPROVAL OF CONSTRUCTION
SINGLE FAMILY RESIDENCE ONLY
EXPIRES THREE Y~RS F~OM DATE ~ APPR~AL
NOTE
AREA = 20,879 SQ. FT.
· SUBDIVISION MAP - "MAP OF GREEN ACRES AT ORIENT"
FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON
APR. 15, 1962 AS FILE NO. 3540.
· VERTICAL DATUM = N.G.V. DATUM (M.S.L. 1929)
· SURVEY AMENDED NOV. 5, 2004 TO ADDRESS S.C.D.H.S. NOTI
OF INCOMPLETE APPLICATION. THIS SURVEY MAP IS BASED ON F
SURVEY COMPLETED MAR. 2002.
SURVEYOR'S CERTIFICATION
· WE HEREBY CERTIFY TO JOHN BANER & DENISE
BANER THAT THIS SURVEY WAS PREPARED IN ACCORDANCE
WlTH THE CODE OF PRACTICE FOR LAND SURVEYS ADOPTED BY
THE NEW YORK STATE ASSOCIATION OF PROFESS~
SURVEYORS.
HOWARD W. YOUNG, N.Y.S. L.S. NO.
SURVEY FOR
dOHN BANER &'DENISE BANE
LOT 41 "MAP OF GREEN ACRES AT ORIEN
At Orient, Town of Southold
Suffolk County, New York
County Tax Map District 1000 Section 15 Block O1 Lot
BUILDING PERMIT SURVE'
AMENDED WELL LOCATION
MAP PREPARED
NOV. 5, ;
MAq. 4, :
SCALE 1" = 40' ' I~
dOB NO. 2001--0199
DWG. 2001_0199_bp
N
Lot A~
o
Lot 42 r~~L~ /
.. c, ,bd\wisi°~ at 0