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HomeMy WebLinkAboutAlbertson & Katz o,o�S‘IFFocir JUDITH T.TERRY is P OGyl: Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 Pt? i Southold, New York 11971 REGISTRAR OF VITAL STATISTICS %:" / y 1 O. is Fax(516) 765-1823 RECORDS MANAGEMENT OFFICER MARRIAGE OFFICER �O ��'�/� Telephone (516) 765-1800 `�► FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1535 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : BRACKENBUILT HOMES INC. Address 1 : 1305 JASMINE LANE City St Zip SOUTHOLD NY 11971 Descripton of Proposed Construction or Alteration SANITARY SYSTEM FOR NEW SINGLE FAMILY DWELLING. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. SCHD REF. #R10-96-0057 Name Of Owner ALBERTSON & KATZ Mailing Address 1 City St Zip 0000 Property Address 1 165 LOCUST AVENUE City St Zip SOUTHOLD NY 11971 Tax Map No. section 62.00 block 3 lot 26.000 Cross Street MAIN ROAD Building Permit Number Cross Reference: Issue Date: 9/16/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) . / _3 w SPI O;Lii OFF0141-- • JUDITH T.TERRY ,t._ *AN Town Hall, 53095 Main Road TOWN CLERK % y egZ% P.O. Box 1179 % T REGISTRAR OF VITAL STATISTICS lAso. y ���1$ Southold, New York 11971 Fax(516) 765-1823 MARRIAGE OFFICER O 4 �I RECORDS MANAGEMENT OFFICER O.j 4 4' .' Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER , ,.s°� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SEP 4 TO: Southold Town Building Department FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: September 3, 1996 Transmitted herewith is a copy of application No. 1601 for a Cesspool/ Septic Tank Construction Permit submitted by: Brackenbuilt Homes Inc. for Albertson & Katz . 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. Thank you. Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: p.:-/4-- Se ,o- O< S 5i.v../..".„-).„ di Sign9' i Date OFFICE OF THE TOWN CLERK too • Town of Southold 00rtakke Judith T. Terry, Town Cleric c` � , OG Application No. / e0) Town Ball, 53095 Construction Main Road ��1Z: i' '544 Construction P. O. Box 1179 . � t 1 Southold, New York11971 : tt� ;- , Alteration Telephone OQ�,,'�� $10,00 - Residential (516) 765-1801 1 * .r('" $25.00 - Non-Residential TOWN OF SOUTHOLD • SOUTIIOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for • CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee .$ /c3 DATE 6)/3/ Y6 APPLICANT NAME: BR Ac Qtrt bu t 1'f'' [ w1€ Zrc, APPLICANT ADDRESS: 134 5 crw.skr)in,ek, Lv -50 U n,,o(a ) Y. I ( 7 SEPTIC IL...-CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATIONPe� s► n� Ie Po-(Alb R-S ;de�� as peg 6'0 I (c tau v:� nark' �►- E-SI=N , S-e R bfc.-e,i LOCATION MAP; • Must be attached hereto before permit may be issued. LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION: OWNER OF PROPERTY : AIbeR+ oma OWNER MAILING ADDRESS: /65— 0 U,,$ 4V1. 0 TGi o L J N // 7 OWNER PROPERTY ADDRESS: TELEPHONE NUMBER OF CONTACT PERSON: ab►vi.« U l-C.k.,Q VIS 7 ‘S cf 7,5-S— TAX MAP NO. : Section 6,„2, Block 0 3 Lot .3 6 CROSS STREET ; 1 vI ; R© j BUILDING PERMIT NUMBER CROSS REFERENCE: Signature of A piicant RECEIVED BY: it / AIF Town CI-rlc's Office DATE; 913/1C _. n.. ... . ,• ww v N• ...,�- w...ww:o..W.a{liwwu�uorrM.JluaYSHkmwsaauai�i�,OYt'w:•ui naru•au,n•ru r,r i u uu .mri i „Ju uiu i u iWin,dii i iy iii+ionnuV i NuMuaiJ I St1FF01.IC COUNTY DEPARTMENT OF HEALTH SERVICES SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES • IIC'1ON�$A • FOR APPROVAL OF CONSTRUCTION ONLY Furor FO�i APPROVAL+ COTISTR Test Hole AG AM LY RESIDENCE OR LY OI Brown DATE HS. REF. NO • :• i., { SillDATE t A► Loam . OL APPROVED =�''� �l 2 OF.4 BEDROOMS f ) APPROVED o i n t FOR Pale Br. pvbli a wc2..r Fine /o IRES TI�tFE YEARS FROM DATE OF APPROVAL Coarse Sand / am familiar with the STANDARDS FOR APPROVAL RE) N. Y• S. Rte. AND CONSTRUCTION OF SUBSURFACE SEWAGE MAIN R j sw DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and will abide by the conditions set forth therein and on Ih I7'1 permit to construct. 14( +.. t i I N o SOUTHOLD LOCUST A VE. 2 r N/O/F CORP. a ` 2r moo jo+ O SURVEY OF p,,.., 0---, � S w. %f1 r 15 PROPERTY • 4 3°e O N. 84°47'1°" E. O N to _ A T SOUTHOLD �_, o C� °'Z °''P�- 0.4 w Q_ 2 TOWN OF SOUTHOLD V 3 G W _ V - SUFFOLK COUNTY, N Y. 6 N �! LA = - N \k 1000 - 62 - 03 - 36 4r N ,� V` �- Scale: 1,II77,2= 30' Q s °"� June 25, 1996 r cA ®`n0 e � —1 s I .. o -:-- i I. ' ..„..,. .,..,----- >06 rpir.0,_ tr‘ 13 li3C ri 4 5 „iii1,, .(y_ SUPPLY AND SE�VgGE D ��/ / ctA o g� CONFO• ' DISPOSAL SY7/ / ��t ,Ya ,, ,�y. .` WITH NEW STANDARDS DATED NO STEMS MUST 2, VSEIt 13,1995. • o �b`'`� ��pF NELV ya 4 o °�� a� �' �'�J�+��S ��S A ?EA = 13,3• sq c. .6�S. MFT2 0� �fr ! lk • I'_,, ' _ `� 5 NCO , PJ0 ‘,,:�. , ;_ ANY AL TERA TION al, OR ADDITION TO TMS SURVEY IS A VIOLA T/ON OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, / J.- n �� EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS ,,., ' %NLIC. NO.-49618 The locations of wells and cesspools HEREON ARE VALID FOR TMS MAP AND COPES THEREOF ONLY IF ;whale Ark • 9 6.• -;0 shown hereon are from field observations SAID MAP VR COPIE$ BEAR THE IMPRESSED SEAL OF THE SURVEYOR PECONI �� '�+►'ice WHOSE SIGNATURE APPEARS HEREON. C ', ELEVATIONS ARE REFERENCED c ��O and or from data obtained from others. f516) 765 TO AN ASSUMED DATUM. ADDITOONALLY TO COMPLY WITH SAID LAW THE TERM 'ALTEREL Br P. 0. BOX 909 au MUS-'. BE USED BY ANY AND ALL SURVEYORS UTILIZIdG A COPY 1230 TRAVELER STREET OF ANO r7•ER SURVEYOR'S MAP. TERMS SUCH AS INSPECTED' AND SOUTHOLD, N.Y. 1/97! 'BROUGHT�TO-DATE- ANE NOT IN COMPLIANCE WITH THE LAW. n' ` • 96-204 _