HomeMy WebLinkAboutBaier, Wayne 0'•`O fFO Co
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JUDITH T.TERRY1 Town Hall, 53095 Main Road
TOWN CLERK t N 4 P.O. Box 1179
v' 'rt I Southold,New York 11971
REGISTRAR OF VITAL STATISTICS 4•,*
Fax (516) 765 1823
MARRIAGE OFFICER �J
��
RECORDS MANAGEMENT OFFICER =�l jig
�O d 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. 1757 R Residential X Non-Residential
Fee $ 10.00 Septic X Cesspool
PERMIT ISSUED TO:
Name : ROGER ULBRICHT
Address 1 : 81 TWIN LAWNS AVENUE
City St Zip HICKSVILLE NY 11801
Descripton of Proposed Construction or Alteration
SANITARY SYSTEM FOR SINGLE FAMILY DWELLING.
APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT
OF HEALTH SERVICES. REF #R10-97-0118
Name Of Owner BAIER, WAYNE
Mailing Address 1 BOX 801
City St Zip NOBLETON, ONTARIO CA 0000
Property Address 1 360 NORTHFIELD LANE
City St Zip SOUTHOLD NY 11971
Tax Map No. section 79.00 block 3 lot 3.000
Cross Street BAYV I EW ROAD
Building Permit Number Cross Reference:
Issue Date: 10/24/97 Judith T. Terry
Southold Town Clerk
(TOWN SEAL)
17S
/.-•0 FFOi�c
JUDITH T.TERRY ?1 tt°_F `� Town Hall, 53095 Main Road
TOWN CLERK % y Z P.O. Box 1179
,t Southold, New York 11971
REGISTRAR OF VITAL STATISTICS ' y �*- Fax(516) 765-1823
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER 0,( �,ri sil Telephone(516) 765-1800
FREEDOM OF INFORMATION OFFICER �Zcrf
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Town Building Department
FROM: Linda J. Cooper, Southold Town Clerk's Office
DATED: October 24, 1997
Transmitted herewith is a copy of application No. 1831 for a Cesspool/
Septic Tank Construction Permit submitted by:
Roger Ulbricht for Wayne Baier •
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.
6.- Kcect__
Linda J. Cooper
* * * * * * * * * * * *
I have reviewed the application and location map of the project cited above
and make the following recom dations:
APPROVE �„%
DISAPPROVE
Comments:
{? ignatur
/ tC1J_ 4/1)
BLDG. DEPT. Dated
TOWN OF S UTHOLD
OFFICE Of 'THE TOWN CLERK0'''''''''''''-
Town of Southold .''1 _' A39 �G : Application No.Judith T. Terry, Town Clerk les sTown Hall, 53095 Main Road !� ; Construction i/
P. O. Box 1179 ►+ Alteration
Southold, New York 11971 ,:.....,0_to W;'
Telephone O�.,i. $10.00 - Residential r/
p *0.0
(516) 765-1801 'y01 4�,, $25.00 - Non-Residential
•TOWN OF SOUTHOLD
SOUTHOLD WASTEWATER DISPOSAL DISTRICT
APPLICATION
for
CONSTRUCTION or ALTERATION PERMIT
SEPTIC TANK or CESSPOOL
Permit No. Zf v
Fee $ 10 -------
DATE GC 2 (G"
APPLICANT NAME: o6Ep._ Lijl4o74 0 ,„..- 6,i,
APPLICANT ADDRESS: gflu) 4 LithlklY7 �3
i/ -
tgiWttlE kiii tbeo
4
SEPTIC W CESSPOOL
DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION IU W
6/Nk4 rmi-ctoj D4A pe.2 t0lArr 40 nwc&A-G13-1r
Qen -IQs. 4iuP ntorr f
LOCATION MAP: Must be attached hereto before permit may be issued.
LOCATION OF PROPOSED CONSTRUCTION OR ALTERATION:
OWNER OF PROPERTY: AMYjU A
OWNER MAILING ADDRESS: FC:"X.. 8&i
Noir- rou, DN co, at,i*t LD‘i,ua
OWNER PROPERTY ADDRESS: 3 7O IUDr2---r* FZ
SOC[ 77i-0 L//
TELEPHONE NUMBER OF CONTACT PERSON: 574' 43e- - g346 J `
TAX MAP NO. : Section 67( Block b00 3 Lot by 3
CROSS STREET : 4q (J( J C.) r
BUILDING PERMIT NUMBER CROSS REFERENCE:
1
ignature of Applicant
RECEIVED BY : 10
Town Clerk's Office
DATE: ` c, `0)
OF: SECTION 7209 OF THE PEW YORK STATE EDUCATION LAW _
EXCEPT AS PER SECTION 7209-SLA9DIVISION 2. ALL cERTIFICATioNs
,-- HEREON ARE VALID FOR THIS MAP AND COPES THEREOF OlLY F
• SAID MAP OR COPES BEAR THE IMPRESSED SEAL OF nir sultvEroit
- WHOSE mw4ATURE APPEARS HEREON
ADDI770NALLY TO cows.. WITH SAV LAW TIE TERM 'ALTEI,REp BY'
MUST BE USED BY ANY AIV ALL SURVEYORS unutos A COPY -
OF ANOTHER SURVEYORS MAP. TERMS SUCH AS "INSPECTED"AND
c
'BROUGHT- TO - DATE'ARE NOT IN COMPLIANCE *7TH THE LAW.
•e
A'e//
11'fro-,rd The locations of wells and cesspools
shown hereon are from field observations
and or from data obtained from others.
....... .. ... . . . _. .. _
:1A IN". OP HEALTH SERVICBS
,or curemucnoN ma A
..'.. 4*S-tvii4CE ONLY
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BdiMEort
1 EXPIRESVRFC YPARS PROM DATPDE•L.oOl,...O.A.r..1.•".O•A.•.•.M■q.P1o1.rPS
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SURVEY OF
PROPERTY LI1
AT BAY VIEW
r
I
\i' TOWN OF SOUTHOLD
• SUFFOLK COUNTY NY
, I - • 1000 - 79 - 03 - Od
--.A. onkr7 own 1 S,CALE r r. 30'
1 ''
/ am familiar with the STANDARDS FOR APP -j"Y' ,,-,.ei--, 1,9 7 (t-ev/.5 e64- C,p loc 2
RoJUVALLY 15,197
AND CONSTRUCTION OF SUBSURFACE SEWAGE
DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES
and will abide by the conditions set forth therein and on the
permit to construct.
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P. 0. BOX - 0 ,. . • •
1230 TRAVELER STREET
SOUTHOLD, N.Y. 11971
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ELEVATIONS ARE REFERENCED
AREA = 20,47 sq ft. TO 'AN ASSUMED DATUM.