HomeMy WebLinkAboutJacob, Walter P o��pF SOUTyoI
ELIZABETH A. NEVILLE '` Town Hall, 53095 Main Road
TOWN CLERK #( # P.O. Box 1179
REGISTRAR OF VITAL STATISTICS ell-
N Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFFICERCO � Telephone (631) 765-1500
FREEDOM.OFU
.INFORMATION OFFICER M' southoldtown.northfork.net
SHY — 4 OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
I
1 s
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: May 4, 2007
Transmitted herewith is a copy of application No. 3706 for a Cesspool/Septic Tank Construction
Permit submitted by:
Walter P. Jacob
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:
Signature
49 0-71,07
Dated
• o�$uFFoc,��o
ELIZABETHTOWN CLERK�LE ~� J� —Town Hall, 53095 Main Road
P.O. Box 1179
REGISTRAR.OF VITAL STATISTICS Southold, New York 11971
MARRIAGE OFFICER Fax(631) 765-6145
RECORDS MANAGEMENT OFFICER y?f�l �� Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISTRICT
APPLICATION
CONSTRUCTION or ALTERATION PERMIT
CESSPOOL or SEPTIC TANK
Residential @$10 zor Non-Residential @$25_ Application No.
Permit No.
Applicant Name Wa P Jacob
Applicant Mailing Address_ Po BOX 7$6
James poo I f✓,,( t 19`l7
Septic Tank_/ or Cesspool
Brief Description of Proposed Construction or Alteration IJj�Lo 1'awv'1.� 1•lt�n�e
Location of Proposed Construction/Alteration: ,^
Owner of Property: Loa I Act- P aa,cob
Owner Mailing Address: Po Goy 758
JameW+, wl 11947
Owner Property Address: `470 Loaf Cour+'
Laurol . NY
Name and phone number of contact person /Waltz! Jacob (031-813'896a
Tax Map No: } Section 'i#— ( 02) Block a1_01( Lot ;L
Cross Street l,avrt,l CovrkaAa Lauml Tra;l
NOTE: LOCATION MAP MUST LBE SUBMITTED WITH APPLICATION. NEW
CONSTRUCTION REQUIRES SURVEY WITH HEALTH DEPARTMENT APPROVAL
IA -3///07
r /Signature of icant Date
Received by.e/
LOT 107 _
VACANT
e/31.
\ e%iz S 20.20 50 . W r
(�I� �' h
/80.00, p�
` d '
0'� O° 6/a9 eve/op
%, e
I am familiar with the STANDARDS FOR APPROVAL
so, / \ AND CONSTRUCTION OF SUBSURFACE SEWAGE
o• DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abide by the conditions set forth /herein and on the
permit to construct.
CK
Ns ae°
QP SURVEY OF PROPER T Y
'� AT MATTITUCK
mss,, TOWN OF SOUTHOLD, N. Y.
R�900 `iso \� �s SUFFOLK COUNTY, NY
F / 1000 - 125 - 04 - 24. 11
a SCALE 1" = 30'
".• 1 C, SEPT. 25, 2002
° S4 Oct. I, 2002 (CERTIFICATIONS)
r h� OCT. 25, 2002 f revision J
tih / OCT. 28, 2002 ( revision
Lee 121
Gjp /Vov, /7, 2006 o f Se
CERTIFIED TO: (� P
Q PECONIC ABSTRACT, INC.
—A �< !� FIRST AMERICAN TITLE INSURANCE COMPANY
M �, OF NEW YORK
D � ANDREW WEXLER
DANIEL J. WEXLER "
SHELLEY WEXLER RODMAN
00 v' ,
�R b6��'l The locations of wells and cesspools I F
ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION „ ¢ ,h shown hereon are from field ObSerVallons E
OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. Q'�' and Or from data obtained from others. a
EXCEPT AS PER SECTION 7209 - SUBDIVISION 2. ALL CERTIFICATIONS
HEREON ARE VALID FOR THIS NAP AND COPIES THEREOF ONLY !F
SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR
WHOSE SIGNATURE APPEARS HEREON NOTE, LOT NUMBERS REFER TO MAP OF LAUREL LINKS" J/3ECONlC
ADDITIONALLY TO COMPLY WITH SAID LAW TERM " ALTERED BY " FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE (631) 765 - 5020 FAX f 3f'X.: 6 "l T97
MUST BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY ON MOV. 23, 2001 AS FILE NO. 107/2 P. 0. BOX 909 �"'•------'
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH 'INSPECTED ' AND A -elu-K e 1230 TRAVELER STREET '
BROUGHT - TO - DATE ' ARE NOT IN COMPLIANCE WITH THE LAW. AREA = 30,885 sq. ff. SOUTHOLD, N.Y. 11971
02 - 298