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HomeMy WebLinkAboutDeerkoski, James .. oil ofFo4 JUDITH T.TERRY ttI�0 yt• Town Hall, 53095 Main Road TOWN CLERK y i P.O. Box 1179 1.3- 1� Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER : y* c .. Fax (516) 765-1823 RECORDS MANAGEMENT OFFICER RI 'j ,,,' Fax (516) 765-1800 FREEDOM OF INFORMATION OFFICER /•gi OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT CONSTRUCTION OR ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. 1514 R Residential X Non-Residential Fee $ 10.00 Septic X Cesspool PERMIT ISSUED TO: Name : DAWN AND JAMES DEERKOSKI Address 1 : 32 PEGS LANE City St Zip RIVERHEAD NY 11901 Descripton of Proposed Construction or Alteration NEW SINGLE FAMILY DWELLING WITH SANITARY SYSTEM. APPROVED AS SUBMITTED AND AS APPROVED BY THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES. SCHD REF. #R10-06-0022 Name Of Owner DEERKOSKI, JAMES AND DAWN Mailing Address 1 32 PEGS LANE City St Zip RIVERHEAD NY 11901 Property Address 1 DEER DRIVE City St Zip MATTITUCK NY 11952 Tax Map No. section 1114.00 block 10 lot 2.000 Cross Street WESTPHALIA ROAD Building Permit Number Cross Reference: Issue Date: 8/06/96 Judith T. Terry Southold Town Clerk (TOWN SEAL) a. Of *0100FOLA, O G JUDITH T.TERRY I y1 Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 IA , Southold, New York 11971 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER 0� �1�, Fax (516) 765-1823 � RECORDS MANAGEMENT OFFICER i 01 '�1 61/ Telephone (516) 765-1800 FREEDOM OF INFORMATION OFFICER °� OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD JUL L 51996 TO: Southold Town Building DepartmentTOWN OFSOU HOLD FROM: Linda J. Cooper, Southold Town Clerk's Office DATED: July 24, 1996 Transmitted herewith is a copy of application No. 1579 for a Cesspool/ Septic Tank Construction Permit submitted by: Dawn and James Deerkoski • 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. 4c..oGce., Linda J. Cooper * * * * * * * * * * * * I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: y40., ,y ��7 1`�� / .x ,49 0- 9.- O2-2 Z7;:e'"...), 4'1)5)- ,e *4 i Signatu e fi D7c1 JS/ OFFICE OF THE TOWN CLERK .s9" sees • Town of Southold •••'•OC���CFx`'OG Application No. /S 77 Judith T. Terry, Town Clerk Town Hall, 53095 Main Road �� �� '.c :a. Construction P. O. Box 1179 �... ; Southold, New York 11971 % t.fl �_ � . ?C ' Alteration Telephone ; 140 �6Q�,,••• $10.00 - Residential (516) 765-1801 _ 1 • ,• $25.00 - Non-Residential TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for CONSTRUCTION or ALTERATION PERMIT SEPTIC TANK or CESSPOOL Permit No. Fee '$ DATE jay�� /99(0 APPLICANT NAME: alviv gimes jeerte25-4 APPLICANT ADDRESS: 32 / 6cc7S LI-Alt-,3— .4///t76#6-1c20 . if'.4/y`,e#a r) by_//90/ SEPTIC X CESSPOOL DESCRIPTION OF PROPOSED CONSTRUCTION OR ALTERATION nJ�w NI.4E.1,11161 2 S1-0 t x LOCAT ION MAP: Must be attached hereto before permit may be issued. LOCATION OF PRQ,,POSED CONSTRUCTION OR ALTERATION : OWNER OF PROPERTY: 7, nEJ /�/ je2�4aS/-T- OWNER MAILING ADDRESS: ,<P 1C.G5 i_, 1.17 , w V RANI 1-1S4)o Nq ^ • OWNER PROPERTY ADDRESS: 2 DZYV� f niq tT 1 T(c.1&, N`I I lg S 2- TELEPHONE TELEPI-LONE NUMBER OF CONTACT PERSON : 7.27-(0j78 TAX MAP NO. : Section 1 /L4 Block 10 Lot 2. CROSS STREET: .C.,S(L .rz,)1 QEF WLsTF?L)vi BUILDING PERMIT NUMBER CROSS REFERENCE: Sim' ture of Ap'icant RECEIVED BY : ownlerk's ffice DATE: 7- c . , • • • t' F - SUFFOLK CO. HEALTH DEPT. APPROVAL H. S. NO. I, LOT tn�lO .�R►EFE2TrO/yM�A.____ } PEER PA/4L�K — t,H �' OF- LOPE QTY• PLED IN THE SUFTro✓.CLL1G� S OOFICE PLEASE NOTE, __. AS MAS' NI0.3244, Sanitary system is not to be Ui2VEYED POQ 2, CO. NTOUQs REEE tZ TO MEAN SEA placed under driveway area, �` EvEL NGV — — _ ©E N tS ETT STATEMENT OF INTENT AT THE WATER SUPPLY AND SEWAGE DISPOSAL WETLAi1DS _ _ tkkATT1TUC k ; , ++� SYSTEMS FOR THIS RESIDENCE WILL ,— ,— --* �- ,07ONFORM TO THE STANDARDS OF TW 30 E. _ - -,. .. _ 5�:.'N. �D N.Y,T�: HEALTH SERVICES. _,.�__� SUFFOLK CO. DEPT. OF HE •Aft`t 1 S Y _ OLf3 OITCM= �� � l ___''^. S J APPLICANT i7 % �n . ` SUFFOLK COUNTY DEPT. OF HEALTH 75' C3 :..�1`_'3 `WATER SII I AND SEWAGE DISPOSAL SYSTEMS •• s k I V I I SERVICES — F o R APPROVAL FOR ' 'CONFORM'iI T. t NEW STANDARDS DATED BIOVF�MB N: . % I95. t . �r CONSTRUCTION ONLY " :• ! I DATE: \�� � { i E H. S. REF. NO. r,N I ----t„ 1 APPROVED: . ........- _...._.. ____— _‘,..t..:_____,........,\ \ I DFCZ A•�-_ t ! i SUFFOLK CO- TAX MAP DESIGNATION: • f ;', �� t - - 1 - \' WELL i i DIST. SECT. BLOCK PCL- r PROP. HQ. j; ; •_ ` — - l ..-� coo (14; f0 2 ,Nj t i GAR. # I j f OWNERS ADDRESS: G ca g .-.^,-,`\ �` `- � --_�J I; f SCALE , - � ' ; 32 PEGS LANE v „��� d ` ;j AQEAt21,574 S.F. ` RIVeatiEAD. NY— 11901 ��e' -4. B`L2 EJPE l C7�.,.sVE Z C FOOLS * M:MONUMENT C?tJUME1,•3T f r - - 1 r -- _— } _ --_�_�-:- �Y i�`'f �0.� '�- =�tr�� __ i TEL.727-6278 .' j `�1 ` .d P' .. DEED: L. N/A. P. Z _- 35' ... ti . t I SUFFOLK.COUNTY'DEPARTMENT OF HEALTH SERVICES pip 1 ___,------1--..--------- [ TEST HOLE ! STAMP Well/ `-.461.1-___„— - t3� t OC°,• ! P. UN FORA { Unauthoraad alteration oraddRfe , .r Mat 1�j.,�.7 GAL, p� , - 'C4 p� AppROVAL OF CONSTRIJCTI t0 this survey is a Violation of _---- -fz z � �><Sa'�YiZ'cP94L}tea,)N. cA --�--- ♦ ' ' y .. ��fa gLNGI FANIILY RESIDENCE ONLY F uiof 7208 of the New Yodc State x.4.5.05 20• W. �,� t 0 - JUN N �3 ��3 a'� 700-....„0- "' �. , • �� Copies of this surveymap notbearing ♦.�yt*o Iand su!!���� 1siA l D v-- �� j ( embossed seal slid lU b6 teonsidered f vr .�� 1 ss t, r �` � / i I or to be a vafd true Copy survey 1 / r�{sr Y� FOR L� . :i`. .M r I f I rant fors/horn i s / - � r �+r vend orson s bah the s prepared and an has behalf to the r�.� FIRES THREE YEARS FROM DATE OF APPROVAL tate , enfat agencyf d ( ! lendx g nstP.utfon listed hereon and j — • ALT tF is the assignees of the lending MA- II A SO �- j --� j , � ' 1transferable �� .. ___ 4 t , V,e' G/0 ��' (c/A Te.�, ( CL to add Guarantees are not subsequent [ 1 to owners. nal instrt�t:ons or subsequent ,.a s CINDY'LANE I 1 /Vo7zz , �E Qum E owners. 6 :LC.64 ` , -^� ' SEA._ — ` )�. _Q C/1,_.._ �. O ' •\� 1 I F,t. t i •mss ZSSfD t�E r J ± f2E5ft t�FCE�, _ ►1"Q `,\GK V. + is t O ;c O0 • 'Gra ,t \ \ AS St..;2VEVED MA12.13; t996 * TAT w RODE ICK VAN TUYL. P � _, ." Y `r f :tis LS 256 a,f _ ?�L LICENSED LAND SURVEYORS i •.f LAND 5 t' + i~..- GREENPORT NEW YORK ff • r� .: -a.-.' ,•..k,.: